Fuch's Endothelial Corneal Dystrophy and
Lasik, PRK, LASEK, Epi-Lasik, RK, RLE, etc.

Corneal endothelial cell dystrophy, also called Fuch's Dystrophy, occurs when endothelial cells gradually deteriorate without any apparent reason.

The endothelium acts to remove excess moisture from the cornea, thus preventing abnormal edema. As more endothelial cells are lost or become defective over the years, the cornea becomes less efficient at pumping water out of the stroma. This causes the cornea to swell and to distort vision.

Eventually, the epithelium also takes on moisture, resulting in pain and severe visual impairment. Epithelial edema damages vision by changing the cornea's normal curvature, and causing a sight-impairing haze to appear in the tissue. Haze apparently occurs because the fluid displaces the arrangement of the corneal fibrils, causing them to interfere with the transfer of different wavelengths of light energy. Epithelial edema can also produce tiny blisters on the corneal surface. When these blisters burst, they are extremely painful.

Depigmentation of the iris in the affected eye may be noticed.

Fuch's Dystrophy is a contraindication for incision-based refractive surgery techniques, such as AK, RK, conventional or custom wavefront Lasik, and All-Laser Lasik. It is an absolute contraindication for P-IOLs, which are known to cause endothelial cell loss. Surface ablation techniques such as PRK, LASEK, and Epi-Lasik may (emphasis on "may") be appropriate in some circumstances, however advanced Fuch's Dystrophy would be a contraindication for these procedures as well. Fuch's Dystrophy is not necessarily a contraindication for RLE. RLE is exactly the same as cataract surgery, and cataracts are directly related to Fuch's Dystrophy about 15% of the time.

Fuch's Dystrophy is most common in adults in their 40s and 50s, affecting women more than men, but normally does not become problematic until the patient is in their 50's or 60's. It tends to be inherited with half of the members of a family being affected; however the severity is variable and visual problems may not occur. Generally it affects both eyes.

The most noticeable initial symptom of corneal endothelial cell dystrophy is blurry vision, particularly evident when first awakened because while the eyes are closed during sleep allowing less fluid is able to evaporate. Vision improves as the day goes on and more fluid evaporates. These are also symptoms of naturally occurring and refractive surgery induced dry eye, which is not at all related to Fuch's Dystrophy.

To treat for endothelial cell dystrophy, steps are taken to remove moisture from the eyes, using different ointments and eye drops. Blowing dry dehumidified air across the cornea with a hair dryer can sometimes help. If corneal blisters develop, soft bandage contact lenses can provide some pain relief. These measures often fail to stop the progression of the condition, so DLEK or PKP may be needed.

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.