WOC addresses major cataract controversies

WOC addresses major cataract controversies


At WOC 2012 Pravin Vaddavalli MD presented the case for a combined cataract-Descemet's stripping endothelial keratoplasty (DSAEK) procedure, arguing that there were many good reasons to favours such an approach.

He cited, for instance, the fact that the combined procedure was just one procedure and that the patient will need DSEK anyway, as well as issues with IOL power calculations, visibility issues, visual function and morphological changes in Fuch's dystrophy which tilt the balance in favour of combined procedures. He also noted that the rate of endothelial cell loss is higher in pseudophakes.

The counter view was presented by Rudy Nuijts MD, who said that there was no real justification for performing combined procedures in Fuch's dystrophy patients and that staged procedures are safer and deliver better outcomes.

Dr Nuijts' said the criteria for staged procedure selection should be based on factors such as the patient's corneal thickness, early morning decompensation, level of endothelial cell density, firmness of the cataract and the quality of vision measurements. He said that a staged procedure, which entailed cataract surgery followed by DSAEK results in more stable lens-iris diaphragm and consequently easier DSAEK surgery.

This approach also resulted in less endothelial cell loss for less experienced DSAEK surgeons. In a staged procedure where DSAEK is followed by phacoemulsification, Dr Nuijts recommended this strategy for severely decompensated corneas in order to enhanced the safety of future cataract surgery.