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Fuch's Endothelial Corneal Dystrophy

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

Image of area in cornea where cells are dead due to fuchs dystrophy.  
Fuch's Dystrophy is a contraindication for any elective eye surgery including Lasik.  

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.


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Recent Fuch's Dystrophy Journal Articles...

Related Articles

Corneal graft rejection in African Americans at Howard University Hospital.

Saudi J Ophthalmol. 2011 Jul;25(3):285-9

Authors: Ferdinand L, Ngakeng V, Copeland RA

PURPOSE: There is scarcity of data in the literature on cornel graft rejection rate in patients exclusively of African ancestry. The purpose of this study was to evaluate the rejection rate of corneal transplant surgery performed at Howard University Hospital on such patients over a 15 year period.
DESIGN: A retrospective evaluation was performed of the cornea graft rejection and corneal graft failure rate in 125 penetrating keratoplasties (PKPs) done by one corneal specialist at Howard University Hospital from January 1, 1990 to August 31, 2005.
METHODS: Of the 125 patients, 62 were eliminated from the study because of re-grafted eyes, non-African descent, primary graft failures, follow-up less than 1 month and lack of availability of charts. This study, therefore, studied and recorded data from 63 penetrating keratoplasties of 63 eyes from 60 patients.
RESULTS: Episodes of graft rejection were documented in 23 eyes (36.5% of cases). Nine out of the 23 graft rejections manifested to secondary graft failure (39%). Overall, there were nine out of the 63 PKPs (14.3%) that resulted in secondary graft failure over the past 15 years. The major diagnostic categories were bullous keratopathy 24 (38%), keratoconus 10 (15.8%), Fuch's dystrophy 4 (6.3%), other 20 (31.7%). Of the cases with episodes of rejection and failure, 4.3% and none were attributable to keratoconus, 30.4% and 22.2% for bullous keratopathy, and 8.7% and 22.2% for Fuch's dystrophy, respectively. Also, best visual acuity was looked at in patients with rejection episodes. None of the patients had a pre-op visual acuity 20/40 or better; however, post-op PKP 2 (8.7%) of patients achieved 20/40 or better. Also, 4 (17.4%) of patients had a pre-op visual acuity between 20/50 and 20/150, but post-op PKP best visual acuity between 20/50 and 20/150 was increased to 9 (39.1%).
CONCLUSION: At 36% the prevalence of corneal graft rejection was one of the highest in the reported literature. But only 14% of those episodes resulted in graft failure which is one of the lowest in the published literature. This study demonstrates that patients of African ancestry may have a higher rejection rate which does not necessarily result in graft failure.

PMID: 23960938 [PubMed]


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