TRIPLE VS NONSIMULTANEOUS PROCEDURES IN FUCHS DYSTROPHY AND CATARACT

Objectives: To determine the outcome and refractive status after tripl e and nonsimultaneous procedures for Fuchs' endothelial dystrophy and cataract. Design: Records of 236 patients with Fuchs' endothelial dyst rophy who were examined during 1988 were reviewed retrospectively. Sub jects: Group 1 consisted of 93 patients who had triple procedures (pen etrating keratoplasty, extracapsular cataract extraction, and posterio r chamber intraocular lens implantation); group 2 consisted of 32 pati ents who had nonsimultaneous procedures (penetrating keratoplasty foll owed by extracapsular cataract extraction and posterior chamber intrao cular lens implantation). Variables in the first eye that had surgery for each patient were compared between the groups by means of unpaired t tests and Fisher's exact test. Results: Mean follow-up after underg oing transplantation was 6 years in group 1 and 8 years in group 2. Cl ear grafts were obtained in 89 (96%) of eyes of group 1 and in 29 (91% ) of eyes in group 2 (P=.37). A best-corrected visual acuity of 20/40 or better was achieved in 60 (65%) of eyes in group 1 and in 21 (66%) of eyes in group 2. Refractive errors within 2 diopters of emmetropia were found in 37 (42%) of eyes in group 1 and in 15 (48%) of eyes in g roup 2 (P=.51). Mean refractive cylinder was 3.9 diopters in group 1 a nd 4.1 diopters in group 2 (P=.67). Conclusions: There was no statisti cally significant difference in the outcome and refractive status afte r triple and nonsimultaneous procedures. To avoid increased cost and d elay in visual rehabilitation, we recommend a triple procedure for pat ients with Fuchs' endothelial dystrophy and visually significant catar acts.