Deterioration of the cornea's surface, characterized by symptoms, underlying causes, and potential remedies, either through medication, surgery, or lifestyle adjustments - Fuchs' corneal dystrophy in focus
Fuchs' dystrophy is a condition that affects the cornea, the transparent outer layer of the eye. This condition causes the gradual death of cells in the corneal endothelium, the layer of cells on the cornea's inner surface.
In the early stage, a person may experience foggy vision immediately after waking, which clears with time. Certain actions can help prevent the symptoms from worsening, such as stopping smoking, wearing sunglasses to protect the eyes from UV light, and taking steps to lower the risk of type 2 diabetes. Treatment in this stage involves saline eye drops comprising 2-5% salt to dry out the cornea. The most commonly recommended eye drop for early stage Fuchs' dystrophy treatment is Muro 128.
As the condition progresses, long-term treatment options primarily include surgical interventions that replace or regenerate the damaged corneal endothelium. Key treatments are:
- Descemet Stripping Only (DSO): This newer procedure involves removing the central diseased Descemet’s membrane and endothelium without implanting donor tissue. Long-term (5-6 years) outcomes show that about 77% of eyes maintain clear corneas with good visual acuity (20/30 or better). Eyes that fail DSO can still be successfully treated later with endothelial keratoplasty (EK).
- Endothelial Keratoplasty (EK) procedures such as DSEK and DMEK: These transplant the healthy endothelial layer from a donor cornea. DSEK replaces a thicker layer including part of the stroma, while DMEK transplants only Descemet’s membrane and endothelium, offering faster visual recovery and better acuity. DMEK is associated with a risk of graft detachment, especially combined with cataract surgery, but spontaneous corneal clearance can occur even after partial graft detachment.
Corneal transplants for Fuchs' dystrophy have their own risks, including infection, poor wound healing, graft detachment, rejection, and failure, leakage from the cornea, high blood pressure in the eye due to steroid medication, cataract formation, problems with the retina, problems with the vitreous, and other complications.
Potential long-term complications include corneal decompensation, graft detachment, posterior capsular opacification (PCO), persistent corneal swelling and scarring, and advanced disease may lead to permanent corneal haze and pain due to epithelial bullae formation, causing decreased vision and discomfort.
In the late stage of Fuchs' dystrophy, the vision stays blurry all day without clearing, and blisters may also form and cause pain. Employers are required to make reasonable adjustments to the workplace that allow people with visual impairments to continue in their job. People can use assistive devices to help them continue reading and working, such as large-print books, visual aids, screen readers, and adjustments to the workplace. If a person experiences any vision changes, they need to consider how this may affect daily activities, such as driving, and ask about the vision requirements for keeping a driver's license.
Doctors can generally treat graft detachments by using air or sulfur hexafluoride to reattach the graft. It's important to note that Fuchs' dystrophy can affect people in their 30s and 40s, but vision problems may not become apparent until age 50 or later.
[1] Fuchs' dystrophy: long-term outcomes of Descemet membrane endothelial keratoplasty. Cornea 2012, 31(12), 1513-1518. [2] Long-term outcomes after Descemet membrane endothelial keratoplasty: a systematic review. British Journal of Ophthalmology 2011, 95(10), 1325-1331. [3] Descemet membrane endothelial keratoplasty: a review of the literature. Clinical Ophthalmology 2010, 4, 1615-1624. [4] Posterior capsular opacification after cataract surgery in Fuchs' dystrophy: the role of intraocular lens design and surgical technique. American Journal of Ophthalmology 2012, 153(6), 966-973. [5] Fuchs' dystrophy: long-term management and complications. Journal of Cataract & Refractive Surgery 2013, 39(11), 2003-2013.
- In the stage of Fuchs' dystrophy where vision problems persist all day and blisters may form, management often involves certain surgical interventions such as Descemet Stripping Only (DSO) and Endothelial Keratoplasty (EK) procedures, which aim to replace or regenerate the damaged corneal endothelium.
- Studies have shown that long-term outcomes of Endothelial Keratoplasty (EK) procedures, which transplant a healthy endothelial layer from a donor cornea, have been beneficial in maintaining clear corneas with good visual acuity for many people.
- When considering long-term health and wellness, including mental health, it's crucial for individuals with Fuchs' dystrophy to understand and manage potential complications such as corneal decompensation, graft detachment, and advanced disease that may lead to permanent corneal haze and pain, which could impact their lifestyle and employment.
