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Different kinds of cataracts- submitted by Lucy B/MN: http://www.visionweb.com/content/consumers/dev_consumerarticles.jsp?RID=7 Types of Cataracts (including statement about fast-acting cataracts as a result of steroid use)- submitted by Rita G/IA: http://www.visionweb.com/content/consumers/dev_consumerarticles.jsp?RID=7 Multifocal, progressive lens implants- please note that due to the aberratations that might produce nighttime glare and halos, it may not be a good idea, ESPECIALLY for fuchs' patients- submitted by Rita G/IA: Potential risk to fuchs' patients when doing cataract surgery- submitted by Nancy P/VA:
http://www.ncbi.nlm.nih.gov/pubmed/19910792 ...More on risk to fuchs' patients when doing cataract surgery- submitted by Nancy P/VA: http://www.ncbi.nlm.nih.gov/pubmed/19201480?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed ...and even More on risk to fuchs' patients when doing cataract surgery: ( PLUS more on risk to fuchs' patients on bottom of this page)
Possible Diplopia after Cataract surgery- submitted by Mardi/Canada:
Main Entry: dip·lo·pia Pronunciation: dip-l-p-
Function: noun
: a disorder of vision in which two images of a single object are seen because of unequal action of the eye muscles -- called also double vision - dip·lo·pic /-l-pik, -läp-ik/ adjective Possible Complications after Cataract Surgery- submitted by Mardi/Canada:
Different kinds of cataract lenses- submitted by Mardi/Canda:
Medical Study done on pre- and post-cataract surgery glare- submitted by Mardi/Canada:
Post-Cataract surgery vision changes- submitted by Mardi/Canada:
Another Medical Study done on post-Cataract surgery vision changes- submitted by Mardi/Canada:
Slide show of Cataract Surgery- note: very graphic - submitted by Rita/SD:
Medical Study on risks of having cataract surgery done same time as T- submitted by Mardi/Canada:
Information on dangers of cataract surgery on fuchs' patients- provided by Mardi/Canada (please scroll down to the bottom of the webpage for the information about cataracts and fuchs'):
Partial list of drs who do cataract surgery around the world- provided by Eleanor:
The section here about cataracts even tells about different KINDS of cataracts (submitted by Denise/AZ:
Cataract surgery from the patient's perspective.... including interesting photos like one of his cataract lens.... provided by Mardi/Canada:
More information on cataracts.... including information on HOW CATARACTS MAY "MASK" PROBLEMS WITH THE RETINA.... provided by Mardi/Canada:
Protecting the corneal endothelial cells during cataract surgery
Posted by
Uday Devgan, MD, FACS
February 19, 2009 09:00 AM
 Protecting the corneal endothelial cells during cataract surgery
Posted by
Uday Devgan, MD, FACS
February 19, 2009(posted on: http://www.osnsupersite.com/blogs.aspx ) Patients who have both Fuchs' endothelial dystrophy and cataracts pose a challenging situation. The cornea continues to decompensate with time, but this can be hastened by the side effects of cataract surgery. The ultrasonic energy from phacoemulsification as well as the fluid flow through the eye can cause further damage to the corneal endothelial cells.
In evaluating these patients, the cornea should be carefully examined with particular regard to the corneal endothelium. If there is mild stromal edema, this can be noted at the slit lamp as well as by increased thickness on pachymetry. A specular or confocal microscope allows for direct visualization of the endothelial cells to examine cell density and morphology. Intraoperatively, the flow rate should be decreased to minimize the amount of balanced saline solution that is put through the eye. Phaco power modulations can be used to help limit the amount of ultrasound energy placed into the eye. A mechanical method of nucleus disassembly such as chopping can further decrease the required ultrasound energy. And most importantly, a dispersive viscoelastic should be used to provide protection of the endothelial cells during surgery. And periodically, during the surgery, more dispersive viscoelastic can be applied for continued protection. Postoperatively, these patients can do very well; however, they may have a prolonged course of healing. I tell patients to remember that Fuchs' is a progressive condition and that they may decompensate years after the cataract surgery. Fortunately, new endothelial transplantation techniques provide a remedy for this situation as well.
Making an informed decision when both cataract and cornea transplant surgery are needed - Submitted by Mardi/Canada
Introduction I have noticed that many persons in our group know that they will require both cataract and cornea surgery sometime in their future. Because of my personal lack of knowledge at the time about the implications of these decisions for persons suffering from Fuchs Dystrophy, I relied on my ophthalmologist to make the best choice for me. Unfortunately he did not recognize that I was one of the 1 % of the population with our condition and thus my life with Fuchs began. ( NB I have told my story in the information section of the library.) I feel so strongly that the lack of knowledge was what brought me to my present situation, that I want to summarize for others, an article that explains the implications of having the cataract removed before being diagnosed with Fuchs. Everyone must make his or her own choice regarding these important decisions, but hopefully this information will be of some use. (If you want to read the article for yourself, you will find it at www.emedicine.com/OPH/topic64.htm ) ==================================================================================== The Article is entitled "Corneal Edema, Postoperative" by Dr. Michael Taravella Associate Professor of Ophthalmology, University of Colorado School of Medicine, published in 2001.
Corneal edema can become a complication following cataract surgery. Edema is an excessive accumulation of fluid. If this accumulation continues, first stromal ( the middle layer of the cornea), then epethelial (the outer layer) edema of the cornea develops. The history of this development parallels the development of the intraocular lens (IOL) As surgical techniques and lens design improved, the incidence of this complication has decreased dramatically. However it still remains an important cause of visual disability following routine and complicated cataract surgery,
Cornea transparency is in large part dependent on the ability of the cornea to remain in a dehydrated state. It is affected by several interdependent factors. The epithelium and the endothelium (the innermost layer ( layer affected by Fuchs ). are both semipermeable membranes that create a barrier to the flow of water into the cornea. Evaporation from the cornea tear film results in slightly hypertonic tears (having a higher osmotic pressure than a surrounding medium or a fluid under comparison ) that tend to draw the fluid out of the cornea. Intraocular pressure tends to drive the fluid into the cornea. However the most important influence on the cornea working properly is the presence of an active metabolic pump in the endothelium.
The endothelium is a single layer of cells present on the back of the cornea. The site of the pump is within these cells. Cell density at birth can be as high as 7500 cells decreasing to an average of 2500-2700 in older adults. these cells are not capable of replacing themselves . The normal rate of endothelial loss after age 20 is approximately 0.5% per year.
Surgical trauma, inflammation, and corneal dystrophies can accelerate this normal aging loss. The cornea is critically damaged when the cell count drops to 300-500 and corneal edema develops.
Currently this development occurs in 0.1% of patients undergoing cataract surgery. But in certain patients this incidence can rise to as high as 5% with certain styles of intraocular lenses. Patients of Northern European descent have an increased incidence of Fuchs Corneal Dystrophy. This condition pre-disposes to the development of post-operative cornea edema. Fuchs also occurs 3 times more frequently in women than men. Older patients who have less endothelial reserves are more prone to develop this problem. Corneal dystrophies such as Fuchs are sometimes overlooked in the pre-operative exam where the finding of cornea guttata are subtle This highlights the need for careful pre-operative slit lamp examination to help identify patients at risk for the development of post-operative corneal edema. If cornea guttata are noted on slit lamp examination, then further tests should be performed. It is very important to identify and counsel patients at risk of developing corneal edema. ==================================================================================== I hope this alerts you to the increased risks associated with any surgery to the eye if you are a Fuchs patient. If you want to read the entire 16 page article that I have taken this information from, go to the above website. Submitted by Mardi/ Canada 02/14/05 Copyright © FuchsSupport Owner. All Rights Reserved. No part of this website (including the logo) may, for commerial, profit-making, non-profit organization, or other non-personal purposes, be reproduced in any form, or stored in a database or retrieval system, or transmitted or distributed in any form by any means, electronic, photocopy, or otherwise, without prior written permission of the author. | |
