Triple vs nonsimultaneous procedures in Fuchs' dystrophy and cataract

Objectives: To determine the outcome and refractive status after triple and nonsimultaneous procedures for Fuchs' endothelial dystrophy and cataract. Design: Records of 236 patients with Fuchs' endothelial dystrophy who were examined during 1988 were reviewed retrospectively. Subjects: Group 1 consisted of 93 patients who had triple procedures (penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens implantation); group 2 consisted of 32 patients who had nonsimultaneous procedures (penetrating keratoplasty followed by extracapsular cataract extraction and posterior chamber intraocular 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 undergoing transplantation was 6 years in group 1 and 8 years in group 2. Clear 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 group 2 (P=.51). Mean refractive cylinder was 3.9 diopters in group 1 and 4.1 diopters in group 2 (P=.67). Conclusions: There was no statistically significant difference in the outcome and refractive status after triple and nonsimultaneous procedures. To avoid increased cost and delay in visual rehabilitation, we recommend a triple procedure for patients with Fuchs' endothelial dystrophy and visually significant cataracts.