Effectiveness of the soft-shell technique in patients with Fuchs' endothelial dystrophy

Purpose: To evaluate the protective ability of the soft-shell technique in patients with senile cataract and Fuchs' dystrophy having phacoemulsification with intraocular lens (IOL) implantation. Setting: Department of Ophthalmology, Railway Hospital, Katowice, Poland. Methods: Sixty-one eyes of 54 patients (37 women, 17 men) with clinically confirmed Fuchs' dystrophy and cataract had clear corneal phacoemulsification and implantation of an intracapsular posterior chamber IOL with sodium hyaluronate 1% (Healon) or chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) in combination with sodium hyaluronate 1% (Provisc) in 1 package (DuoVisc). The central corneal thickness (CCT), measured with a Pocket Precision ultrasonic pachymeter (Quantel Medical, Inc.), was compared preoperatively and 1 day, 1 week, and 1 and 6 months postoperatively. Results: The mean preoperative CCT was 549.5 mu m +/- 29.3 (SD). The postoperative increase in CCT over preoperative pachymetry measurements remained statistically significant in both ophthalmic viscosurgical device groups throughout the entire follow-up, from the first day to the sixth month after surgery (P <.0001). The maximum increase in CCT in both groups was on the first postoperative day, and it was significantly higher in the Healon group. Six months postoperatively, patients in the Healon group had a significantly greater CCT increase (P = .008). Conclusion: The soft-shell technique effectively protected the compromised endothelium in patients with Fuchs' dystrophy, proving its advantages in eyes with moderately damaged endothelium.