Ocena gęstości komórek śródbłonka po operacji usunięcia zaćmy metodą fakoemulsyfikacji u pacjentów z dystrofią rogówkową Fuchsa w porównaniu z pacjentami bez nieprawidłowości w obrębie śródbłonka rogówki
Evaluation of Corneal Endothelial Cell Loss (ECL) after Phacoemulsification Procedure in Patients with Corneal Fuchs Dystrophy Compared to Patients without any Endothelial Pathology
Anna Kamińska, Justyna Izdebska, Jacek P. Szaflik, Urszula Kołodziejska
Katedra i Klinika Okulistyki II Wydziału Lekarskiego Warszawskiego Uniwersytetu Medycznego Samodzielny Publiczny Kliniczny Szpital Okulistyczny w Warszawie Kierownik: prof. dr hab. n. med. Jerzy Szaflik
Summary: Purpose: To evaluate corneal endothelial cell loss (ECL) after phacoemulsification procedure in patients with corneal Fuchs dystrophy compared to patients without any endothelial pathology operated in Department of Ophthalmology, Medical University of Warsaw, Poland.
Material and Methods: In this prospective study 40 patients (40 eyes) qualified to cataract surgery were included to the study group. They were divided in to 2 groups of 20 patients. Group A – patients with cataract and Fuchs corneal dystrophy with diagnosis confirmed using in vivo confocal microscopy; Group B – patients with cataract and without any endothelial pathology. In vivo confocal microscopy of the central cornea using CONFOSCAN 3 (Nidek Technology), was performed in all cases preoperatively and postoperatively (5 weeks). Endothelial cell density (ECD – cells/ square millimeter), endothelial cell loss (ECL = preoperative ECD -postoperative ECD), and proportional loss of cells [PLC = (ECL/ preoperative CD) x 100%], were calculated.
Results: Mean preoperative ECD in group A was 1057 (ranged 590-1207) and in group B 2180 (ranged 1530-2417). The loss rate of endothelial cell was 16.4% in group A and 9.8% in group B. There were no significant differences in BCVA between the two groups. Localized corneal edema was observed in 4 eyes from group A during first 3-4 days after surgery. However permanent using of hyperosmotic drops weren’t necessary. All corneas stay clear, without any signs of decompensation.
Conclusions: Cataract surgery in the setting of Fuchs dystrophy can be performed succesfully. Preoperative evaluation of endothelium and its protection during phacoemulsification procedure seams to be as important as surgeon experience. However Fuchs dystrophy is a progressive disorder so possibility of keratoplasty in the future should be taken in to consideration. In some cases cataract phacoemulsification can be the first step of treatment before deep endothelial lamellar keratoplasty.
Słowa kluczowe: dystrofia śródbłonkowo-nabłonkowa Fuchsa, faksemulsyfikacja zaćmy, śródbłonek rogówki.
Keywords: Fuchs dystrophy, cataract phacoemulsification, corneal endothelium.