Descemet Membrane Endothelial Keratoplasty for Fuchs' Endothelial Dystrophy

Since the most common cause of blindness is the development of FSD, a better understanding of the disease may lead to the development of treatments which minimize the impact of the disorder and halt the progression of the disease. A multidisciplinary team of ophthalmologists, pathologists, and patient advocate will be essential for patient care.

FED can go away in some individuals, but is usually irreversible at some point during the natural development of the disease. It is extremely variable and the time in which the edema is noticed may vary from hours post operatively to decades after the eye was first operated. There is no cure for FED.

The initial management of FED should be focused on correction of ocular hypotony and the eye examination by a competent ophthalmologist must be obtained (ophthalmologist is essential). Fluorescein angiography and spectral domain optical coherence tomographic imaging help to diagnose and to follow the progression of FED in a clinical setting. No curative treatment for this disease is available. Management focuses on decreasing further deterioration of the eye and on preventing or treating complications. Treatment options are available for many types of complications.

FECD is an underdiagnosed and underresearched eye disease among the US population, which suggests that it may be more common than previously recognized. Better understanding of the disease and awareness of the disease among ophthalmologists and other primary care providers may allow earlier preventive measures to be taken.

Vision changes in Fuchs' endothelial dystrophy may be related to retinal detachment. Some signs include cataract formation, visual field restriction, loss of central corneal endothelial signal, loss of central visual acuity and photophobia. Diagnosis is usually evident during adolescence, and in a subset of cases, retinal detachment may be a very early sign of FED. Thus, screening for FED, such as an examination of the retina, should be considered for any patient with bilateral vision problems before the age of 10 years.

It is considered impossible to define a cause of FED. The current theories are: vascular lesions that may not be due to a systemic immune-mediated process, and a metabolic or nutritional insult that may affect the blood vessels, either before or during development. The most likely hypothesis is that environmental factors have a synergistic effect with inheritance. The clinical appearance of FED is usually a consequence of irreversible damage to the vascular endothelium, which leads to a loss of the vascular tone, which in turn causes vessel collapse.

Descemet membrane endothelial keratoplasty was more effective than a 1-week regimen of topical steroid eye drops for the treatment of Fuchs' endothelial corneal dystrophy. Treatment with either treatment did not enhance recovery or improve the functional results of this most effective procedure for corneal edema and photophobia.

DMEK is being combined with many different treatment modalities, though some studies have found poorer outcomes when combined with phacoemulsification. It is unclear if this is the case for DMEK as an intravitreal injection.

The vision-threatening and life-threatening complications of FED can be life-threatening when untreated for a prolonged period of time. It is recommended that ophthalmologists evaluate these patients when they are younger than 46 years old because some symptoms may also occur at an older age.

Descemet membrane endothelial keratoplasty can be a rewarding method of corneal graft, especially if one of the main surgeons is experienced with this form of keratoplasty. The early postoperative period can be challenging, although patients are likely to be more comfortable with the surgery during this period as they recover from anesthesiologic and surgical pain, and have time to focus on the physical demands of postoperative rehabilitation. The main postoperative complications are usually minor, but the incidence of severe complications is not negligible.

Currently, researchers are working on the pathogenesis of the disease. It is believed that there are various genes or combinations of genes that are involved in the development of fuchs' dystrophy, as well. Once determined, the genes will be used to block or activate the genes or proteins that are implicated in fuchs' dystrophy.