Update on the Surgical Management of Fuchs Endothelial Corneal Dystrophy

Abstract

Fuchs endothelial corneal dystrophy (FECD) is the most common posterior corneal dystrophy and the leading indication for corneal transplantation in the United States. FECD is slowly progressive, and patients develop gradual corneal endothelial decompensation, eventually resulting in failure of the endothelium to maintain corneal deturgescence. Medical management consists of topical hyperosmotic agents to facilitate dehydration of the cornea, but surgical intervention is often required to regain corneal clarity. The surgical management of FECD has evolved over the past two decades as corneal transplantation techniques have allowed for more selective keratoplasty and replacement of only the diseased layers of the cornea. Prior surgical management consisted of penetrating keratoplasty (PK) that carried significant intraoperative risks associated with ''open sky'' as well as postoperative risks of graft rejection, wound dehiscence, postoperative astigmatism, and prolonged visual rehabilitation. In the past 15 years, endothelial keratoplasty (EK) has become the treatment of choice for endothelial disease, significantly reducing the risks associated with the surgical treatment of FECD. Here we discuss the current surgical management of FECD, including the introduction of Descemet stripping only (DSO), and highlight future investigative efforts.

Cost Burden of Endothelial Keratoplasty in Fuchs Endothelial Dystrophy: Real-World Analysis of a Commercially Insured US Population (2014–2019)

“…Over the years, the surgical management of worsening FECD with corneal transplantation has evolved, with a shift from penetrating keratoplasties to lamellar procedures, primarily endothelial keratoplasties (EK), due to significant intraoperative and postoperative risks associated with penetrating keratoplasty. 7 , 8 In 2018, EK procedures accounted for almost 62% of all corneal transplant surgeries performed in the US compared to 45% in 2010. 9 …”

Assessment of the Quality and Reliability of YouTube Videos on Fuch’s Endothelial Corneal Dystrophy

“…With EK, the risk of surgical intervention including graft rejection, prolonged visual rehabilitation, infection, and post-operative astigmatism has decreased significantly. Patients can now undergo transplantation earlier in the disease course, guided by visual symptoms and clinical findings ( 7 ).…”

To compare corneal confocal microscopy of eyes with Fuchs’ endothelial corneal dystrophy after two different endothelial surgeries

“…Endothelial keratoplasty is becoming the most common surgical treatment for Fuchs' endothelial corneal dystrophy (FECD). 1,2 This type of corneal surgery, unlike penetrating keratoplasty (PK), is less invasive and allows selective replacement of posterior layers of cornea. This ensures a safer and more effective treatment of posterior corneal dysfunction and faster and more reliable visual rehabilitation.…”