Objective: To evaluate the use of preoperative pachymetry in patients with Fuchs' dystrophy who are undergoing cataract extraction to predict the need for future penetrating keratoplasty and to compare these findings with current published recommendations. Design: Retrospective noncomparative case series. Participants: A series of patients with Fuchs' dystrophy (136 eyes) undergoing cataract surgery. Methods: We reviewed the medical records of 136 patients with Fuchs' dystrophy who underwent phacoemulsification and intraocular lens implantation between October 1990 and May 2002. Main Outcome Measures: Preoperative and postoperative visual acuity, pachymetry, and postoperative corneal decompensation requiring penetrating keratoplasty. Results: The average preoperative corneal thickness was 584±39.5 μm (range, 482-674 μm). Fifty eyes (36.8%) had preoperative corneal thickness of <600 μm. The average postoperative best-corrected visual acuity (BCVA) was 20/33 (range, 20/15-20/250). Of the 50 eyes with preoperative pachymetry measurements of <600 μm, 5 (10%) progressed to penetrating keratoplasty; 90% of the 50 eyes did not need corneal transplants within the first year after cataract surgery and had an average postoperative BCVA of 20/35 (range, 20/20-20/200). Of those with a corneal thickness of <640 μm, 83% did not need a corneal transplant within this same time period and had an average postoperative BCVA of 20/50 (range, 20/20-20/200).Conclusions: To avoid unnecessary cost and delay in visual rehabilitation, we suggest changing the current recommendations for an initial triple procedure for eyes with preoperative pachymetry measurements of >600 μm. Our data suggest that current cataract removal techniques allow for excellent visual rehabilitation in patients with Fuchs' dystrophy who have a preoperative corneal thickness of >600 μm, and we suggest that preoperative pachymetry measurements of >640 μm may be a better guideline. This recommendation can be further expanded above 640 μm if a visual acuity of less than 20/20 is acceptable. A prospective randomized controlled study is required for validation of this analysis.
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