Today there are many excellent treatment options for Fuchs’ corneal dystrophy. In the early stages, medical treatment with hypertonic eye drops and ointments such as Muro 128 can be effective at reducing the swelling of the cornea. For some patients, the dystrophy will progress and the pump cells will no longer be able to keep up with the swelling. This is typically when patients will notice the blurry vision. In addition, the guttae changes can accumulate over time and can also affect the vision. It is during these later stages that patients should consider surgical options.
Surgical treatments for Fuchs’ dystrophy have progressed rapidly in the past 10 years and the visual outcomes today can be terrific. As a center of excellence for Fuchs’ dystrophy, Tailored Eyes is proud to be one of the few centers able to offer all of the treatment options for Fuchs’ dystrophy.
One option called Descemet’s Stripping Only (DSO) is where we rejuvenate the cornea without using donor cornea tissue. The central guttae changes are removed from the visual axis to clear the way and no cornea graft is inserted in the eye. This can be helpful for mild to moderate cases of Fuchs’ dystrophy. The advantage of this procedure is no donor corneal tissue is needed. The disadvantages are that the vision recovery can be slow and it may not clear the cornea in about 10% of patients. For the patients who do not regain clear vision after DSO, we would proceed with a DMEK procedure (described below) for the best vision.
Another surgical option, Descemet’s membrane endothelial keratoplasty (DMEK), is a minimally invasive procedure used to rejuvenate the cornea. DMEK surgery is a form of cornea transplant in which human donor cornea tissue is used to restore corneal clarity. As the cornea tissue graft comes from human donors it is a true gift of sight. In DMEK, the diseased Descemet’s membrane and guttae are removed from the inside of the cornea and replaced with a donor graft of similar size and thickness. The graft is unfolded inside the eye and held in place with an air bubble. The air bubble resolves in a few days. DMEK is an advanced, modern technique in which minimally invasive incisions are made and the graft is as thin as possible. The DMEK graft contains the specialized endothelial cells on a membrane with no additional donor tissue. This means the graft is only about 15 microns thick (slightly thicker than a red blood cell) and as a result, the clarity of the cornea after surgery can be spectacular. As the DMEK graft attaches to the back of the cornea, the pump cells turn on and start to clear the cornea. As the cornea clears, the vision improves (typically over 2-4 weeks).
The advantages of DMEK are that it can provide fast vision recovery with excellent visual acuity and quality of vision. The disadvantages are that there is a positioning requirement to lie on your back looking up after surgery (so the air bubble will support the graft) and it can’t be performed in patients with glaucoma tube shunts or anterior chamber lenses. These patients can still benefit from DSAEK surgery (see below).
Descemet’s stripping automated endothelial keratoplasty (DSAEK), is another form of cornea transplant similar to DMEK surgery. As above, the diseased Descemet’s membrane is removed from the inside of the cornea and replaced with human donor cornea tissue. The graft is then unfolded and held in place with an air bubble. The air bubble will resolve over a few days. DSAEK is an older cornea transplant technique that involves slightly larger incisions than DMEK and the donor graft is slightly thicker. The cornea graft in DSAEK consists of donor endothelial cells plus a thin layer of donor cornea stroma (the middle layer of the cornea). As the DSAEK graft attaches to the back of the cornea, the pump cells turn on and start to clear the cornea. As the cornea clears, the vision improves. In DSAEK surgery, the vision recovery can take longer than DMEK (3-6 months), however, it is an excellent option for patients who may have difficulty lying on their back or otherwise cannot have DMEK surgery.