Welcome to Case of the Day!
Today, we’re going to discuss an interesting disease in a lady who came in with this particular problem. This disease is called Fuchs’ dystrophy, which was first described from an Austrian in the late 1800s to the early 1900s.
This disease is characterized by a dystrophy or a problem with the inside lining of the cells of your cornea. The cells of your cornea, which is called the endothelium, line the inside of your cornea. These cells are responsible for pumping the fluid out of your cornea and, therefore, making the cornea stay clear so your vision is clear.
As time goes by, these cells quit working, and gradually, the cornea swells, which then leads to blurred vision. Fuchs’ dystrophy occurs in maybe one percent of the population, and is much higher in women. It is an inherited process, an autosomal-dominant inherited process with a variety of penetration. That is, not everyone gets it, but it is a dominant-type inheritance.
Fuchs’ dystrophy usually can start with a person seeing what are called guttata or little bumps in this endothelial layer, sometimes even as early as their 30s or 40s. It gradually progresses and can start causing swelling of the cornea in their 60s and later.
As far as the treatment of Fuchs’ dystrophy goes, in the beginning, it’s just a medical treatment. A lot of people are trying a hypertonic solution or eyedrop that is placed in the eye, and the salt that is put on the surface of the eye tries to draw out the fluid from the cornea and keep the vision better. That has some success, but not that great a success.
The other choice for many people is to try using a hair dryer. You blow a hair dryer an arm’s length distance from your eyes and dry the cornea out. That helps to thin the cornea down and help the vision in some people.
But if it gets to the point that someone’s not seeing well from this, then the actual treatment is to replace the cornea or in today’s time, to only replace that inside lining of cells. Prior to the last few years, these people had to have a full-thickness corneal transplant where an incision is made all the way to the cornea like a cookie cutter, and then a donor cornea is sutured into place, and many times there is a long healing period before people had good vision with this treatment.
Recently, there has been a new surgical procedure where now just that inner lining of endothelium and a little bit of the Descemet’s membrane underneath it are removed, and then just that layer is replaced. This can even be done without sutures today, and you get a much more rapid recovery of vision and still maintain the outer surface of your eye and cornea, which gives you a better visual result.
People who have Fuchs’ dystrophy typically start complaining of blurred vision and a lot of problems with glare because the cornea swells; light hits the cornea that tends to cause glare, so people complain about blurred vision and glare and just not seeing right. Eventually, it progresses.
Typically speaking, a lot of people end up developing cataracts at the same time, and so cataract surgery is done first, followed by the corneal transplant maybe three or four weeks later. Even if someone doesn’t have a cataract but has developed severe Fuchs’ dystrophy, then we usually end up taking their lens out anyway and doing a cataract surgery-type procedure before there’s much of a cataract because you don’t wanna go back inside the eye after this has been done and do any kind of surgery. In some cases you have to go back; you have to do the cataract surgery or what is called a clear lensectomy, and a few cases where you’re taking the lens out first and then have the cornea replaced.
The success rate of this has gotten very good, and people can do very well with Fuchs’ dystrophy now. It’s a disease that we have a great way of treating as far as surgical repairing is concerned.
If you have any questions about Fuchs’ dystrophy or anything else, you can try contacting us online. If not, may God bless you with healthy eyes and great vision.
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