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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 Bladeless 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.
Looking For Best Lasik Surgeon?
If you are ready to choose a doctor to be evaluated for conventional
or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization.
Locate a USAEyes Evaluated & Certified Lasik Doctor.
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