Fuchs' endothelial dystrophy

What is Fuchs' dystrophy?

Fuchs endothelial dystrophy (FED) of the cornea is slowly progressive degenerative disorder of the cornea which is characterized by death of corneal endothelial cells, ie. the cells maintaining the transparency of the corneal tissue. Unfortunately, the loss of endothelial cells is permanent and progressive because they do not have the possibility of renewal and regeneration. The disease can be inherited as an autosomal dominant disease, although in most cases is sporadic, but also what is important are genetic and environmental predisposing factors such as older age and female sex.
Loss of endothelial cells can also be induced by trauma or intraocular operations such as. cataract surgery. Although you can see the early signs of the disease in people in their 30s and 40s, the disease rarely causes visual impairment before the 50's or 60's.

What are the symptoms?

The disease has three stages and depending upon the state of the cornea is characterized by blurred vision and eventually pain and discomfort.

1. stage of the disease is characterized by the gradual creation of naked regions in the interior of the cornea in which there are no endothelial cells (known under the name "cornea guttata") and consequent thickening of the cornea
2. stage is characterized by endothelial decompensation with consequent blurring of central cornea, and hence the clouding of vision that is worse at the beginning of the morning and improves during the day. Epithelial edema occurs when the thickness of the stroma gets increased by 30%.
3. stage is characterized by permanent edema of the epithelium and bulls (bullous keratopathy) which cause the pain and discomfort for the patient so in addition to bad vision the patient has constantly a painful eye.

Methods of treatment:

The treatment initially aims at reducing corneal edema and providing pain relief. Ointments and drops of sodium chloride and lower intraocular pressure may temporarily relieve the edema. Drops for eye lubrication and therapeutic soft contact lenses are used to alleviate pain and protect the exposed nerve endings. Posterior lamellar transplantation such as DSAEK, or UT-DSAEK is performed when significant vision reduction occurs.