Fuchs'Dystrophy

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OS: IOP: 16 Pachymetry:658 Keratometry:41.80 VA:20/70 Cornea:Endothelial guttata, corneal edema

Symptoms:

Cloudiness, haze, glare on cornea

Painful blisters on corneal surface

Blurry/light sensitive vision

Pain and discomfort

Endothelial guttata

Corneal swelling

Corneal thickening

Fuchs' Dystrophy

Treatment

Replacement of inner corneal layer by: Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK).

Corneal Transplant

Soft contact lenses

Eye Drop/Ointments

Definition:

What is it: Corneal swelling that can cause discomfort, cloudiness, and glare due to inadequate pumping of fluid out of the cornea by the endothelial cells that are slowly dying off.

Current Research:

"Visual acuity and contrast sensitivity following Descemet stripping automated endothelial keratoplasty." -Patients with Fuchs' Dystrophy (128) underwent DSAEK which strips away and replaces the thickened endothelial basement membrane and their post-operative results were observed. Results: Significant improvement in VA were seen among patients (majority Asian and women) at 12 months along with improved contrast sensitivity at 6 months indicating the benefits of this treatment. doi: 10.1136/bjophthalmol-2015-306975. [Epub ahead of print]

"Outcomes of cataract surgery in eyes with a low corneal endothelial cell density." -Patients who underwent cataract surgery with low endothelial cell density(ECD) were evaluated. Results: Out of the 63 eyes tested, 20 eyes had preoperative Fuchs' Dystrophy.Mean ECD after surgery was 611-693 and cell loss was at 11.5%. Regardless, VA improved from .59 to .32 (logMAR) indicating that vision improvement is possible even for those who have a low ECD. doi: 10.1016/j.jcrs.2011.05.039. Epub 2011 Sep 10.

Differential Diagnosis

Low Endothelel cell density: Patient might have had per-operative low endothelial cell density which have caused manifestations seen now after surgery which reduced the cell density.

Ocular hypertension: might be affecting VA, could have been worsening corneal edema in combination with cataract surgery.

Keratitis: Calcification on iris could have let to reduce VA with correction, redness, and discomfort.

Cataract Surgery: Could have reduced endothelial cell density resulting in guttata. Could have had an effect in VA.

Corneal Edema: Due to guttata seen in left eye, pachymetry result of 658 is slightly higher than average in left eye but very high in the right eye suggesting significant corneal swelling.

Patient MRN: 91013353 26 year old Asian Female

Findings:

OD: IOP:17 Pachymetry:818 Keratometry:45.60 VA:20/80-1 Cornea:diffuse bulbus keratopathy with stromal folds