Treating cataracts and Fuch's dystrophy with extracapsular cataract extraction

Extracapsular cataract extraction is a type of cataract surgery where the natural lenses of the eyes are removed, leaving the back of the capsule that holds the lens in place untouched. This method requires a smaller incision than Intracapsular cataract extraction, which removes both the lens and entire capsule.

A local anaesthetic will be utilised to numb the tissues around the eye, and a topical sedative is used to numb the eye itself. The ophthalmologist will then make an entry point in the cornea where the sclera (the white layer of the eyes that covers a large portion beyond the eyeball) and cornea meet. Following the incision, the surgeon will make a circular tear on the front of the lens capsule, a process called capsulorhexis.

The ophthalmologist will carefully open the lens capsule and remove the hard nucleus of the lens using suction to eliminate the softer cortex of the lens after the nucleus has been expressed.

A particular viscoelastic substance will be injected into the empty lens capsule to help it maintain its form while an intraocular lens (a lens implant made of clear plastic) is inserted by the surgeon. The viscoelastic material is removed once the intraocular focal point is properly positioned, and the cut is closed with sutures. A standard extracapsular cataract extraction takes under an hour to finish.

What is corneal Fuchs dystrophy?

Fuchs dystrophy is a hereditary corneal condition. The layer of endothelial cells liable for maintaining adequate liquid levels in the cornea will degrade as the condition advances, causing little bumps (guttae) to develop on the back of the cornea. When too many cells are gone, fluid accumulates in the cornea, causing corneal edema (enlarging of the cornea).

Fuchs dystrophy often affects both eyes and could make your eyesight deteriorate over time. This condition usually starts during the 30s and 40s and numerous patients with Fuchs dystrophy do not exhibit symptoms until they are in their 50s or 60s. Some medications, for example, eye drops and eye ointments may help alleviate the side effects of Fuchs' dystrophy.

Symptoms of Fuch’s dystrophy?

First symptoms of Fuch's dystrophy include blurry vision as a result of the fluid build-up in the cornea. The excess fluid usually develops overnight and causes discomfort when waking up. As the condition worsens, discomfort and blurred vision lasts longer. Other symptoms can be present as well such as:

• Sharp eye pains
• Gritty sensation in the eye
• Discomfort in bright light
• Low colour contrast sensitivity
• Halos and glares
• Fluctuating eyesight throughout the day

Fuch's dystrophy and cataracts

Though not interlinked, patients diagnosed with Fuch's dystrophy can develop cataracts too. In advanced cases or if a patient is diagnosed with both cataracts and Fuch's dystrophy, extracapsular cataract extraction may be prescribed.

Intermittently, a corneal transfer medical procedure might be required following the intraocular medical procedure if:

• Recovery is slow or limited
• Fuchs dystrophy worsens following surgery

Your eye doctor may suggest cataract surgery and corneal transplant simultaneously in circumstances of severe Fuchs dystrophy. By using a combined method, patients benefit from a short recovery period.

Our ophthalmologists at Eyecentric BTMC will suggest a treatment plan that best suits you based on a thorough evaluation.

How is Fuch’s dystrophy diagnosed?

Fuch's dystrophy is typically diagnosed during routine eye exams. Eyecentric ophthalmologists may perform a set of tests to confirm the diagnosis of the condition. The tests assist with identifying other conditions that may also be affecting your vision such as cataracts. The tests may include:

• Slit lamp microscopy - Allows structures of the eye being affected to be observed under high magnification. Through slit lamp microscopy, our ophthalmologists are also able to detect signs of cataracts.
• Specular microscopy - Used to measure the number, shape and density of the endothelial cells.
• Pachymetry - A pachymeter device is used to measure corneal thickness that will determine the treatment that is to be prescribed.

After-care and follow up treatment

You can get back to work the next day although the operated eye will take anywhere from three weeks to three months to fully recover. You are allowed to continue your daily exercises within one to two days after surgery, however, you really want to abstain from rubbing eyes and lifting heavy weight. You are encouraged to wear dark glasses throughout the day and an eye shield over the operated eye at night.

You will be scheduled for frequent check-ups in the following weeks after the surgery to ensure your eyes are healing properly.

Book an appointment with us at EYECENTRIC Bukit Tinggi Medical Centre (BTMC) for a consultation with our highly skilled ophthalmologists and to find the answers you need. They will walk you through the entire process of extracapsular cataract surgery and take the time to explain the risks and considerations involved.