Hello and welcome to Case of the Day. I’m Dr. Croley and today we are going to discuss an interesting disease. A lady came in with this particular problem and this disease is called Fuchs’, as in F-U-C-H-S, Dystrophy, which was first described from an Austrian back, many years ago in late 1800s to the beginning of 1900s.
This disease is characterized by a dystrophy or problem with the inside lining of the cells of your cornea. So the cells of your cornea, which is called the endothelium, the inside lining of your cornea, and these cells are responsible for popping the fluid out of your cornea, therefore making your cornea stay clear so your vision stays clear. So as time goes on, these cells quit working and gradually the cornea swells, which then leads to blurred vision.
Probably it occurs in 1 percent of the population, 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’s a dominant type inheritance. It usually, can start seeing what you call guttata or lower bumps in the endothelial layer, sometimes even as early as 30s or 40s but then gradually progresses, and can start causing swelling of the cornea in the 60s and later.
As far as the treatment of this goes, in the beginning it’s just medical treatment and a lot of people try it on a hypertonic solution or eye drop is placed in the eye and the salt that’s put on the surface of the eye tries to draw out the fluid from the cornea and keeps the vision better. And that has some, you know, success, not that great a success.
The other choice is that many people can try using a hair dryer. So you blow a hair dryer from arms length distance on your eyes and dry the cornea out using that hair dryer and that helps to thin the cornea down and help the vision with some people.
But when 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, actually only replacing that inside lining of cells. So prior to the last few years, these people had to have a full thickness corneal transplant where an incision was made all the way through the cornea, like a cookie cutter and then a donor cornea was sutured into place and many times, there was a long healing period before people have good vision with this treatment.
Recently there’s been a new surgical procedure called the DSAEK where now just that outer or inner lining of endothelium and a little bit of Descemet’s membrane underneath that are removed, and then just that layer is replaced, and this can 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. So, now the treatment for this is now actually called the DSAEK, and it works very well.
So people, typically when they have this, start complaining of blurred vision. A lot of problem with glare because the cornea swells, light hits the cornea and tends to cause glare, so people complaining about blurred vision and glare, and just not seeing right, and eventually, like I said, it progresses.
Typically speaking, a lot of people end up developing cataracts at the same time. And so the cataract surgery is done first, and then this is followed by the corneal transplant, maybe 3 or 4 weeks later. And even if someone doesn’t have a cataract, but has developed severe enough Fuchs’ Dystrophy, then we usually end up taking their lens out anyway, and doing a cataract surgery type procedure before there’s much of the cataract because you don’t want to go back inside the eye after this has been done and doing any kind of surgery, so, in some cases you have to go back, you have to do the cataract surgery or what’s called the clear lensectomy and a few cases where you’re taking the lens out first, and then have the cornea replaced.
So, the success rate of this has gotten very good and people can do very well with Fuchs’ Dystrophy now. So it’s a disease and we have a great way of treating as far as surgically repairing that.
So, if you have any questions about Fuchs’ Dystrophy, or anything else, you can try contacting us through the website, if not may God grant you with a healthy vision and healthy eyes.