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Medical and Surgical Management

Treatment

There currently is no cure for Fuchs' Dystrophy.  In early stages of the disease, vision may be improved with a 5% salt solution.  However, there is no treatment that can actually halt or reverse the course of the disease.  Eventually, in some patients with Fuchs’ dystrophy, surgery may be necessary.  The two options currently available are: Penetrating Keratoplasty (PK) and Descemet’s Stripping with Endothelial Keratoplasty (DSEK).

Scheduling Surgery / Obtaining a Cornea

A donor cornea is needed for both types of surgeries—Penetrating Keratoplasty (PK) and Descemet’s Stripping with Endothelial Keratoplasty (DSEK). 

Once the patient has decided to undergo surgery, the patient's name is entered into a database maintained by the local eye bank.  Because of the highly efficient network of eye banks, surgery can be scheduled electively.  Corneas are always tested for hepatitis, AIDS, and many other diseases before being approved for use. 

You can learn more about corneal transplants and the national network of eye banks at http://www.restoresight.org/general/faqs.htm

Corneal Transplant

Corneal Transplant (Penetrating Keratoplasty)

First, the patient's cornea is carefully removed.  Then the healthy donor cornea is sewn into place.  Other necessary surgery, such as cataract removal, may also completed while the patient is in the operating room.  Corneal transplants usually take only an hour and are performed on an outpatient basis typically with local anesthesia.  The ophthalmologist will decide when it is safe to remove the stitches—typically eighteen months or two years after surgery.

video of corneal transplantVideo of Corneal Transplant

Descemet’s Stripping with Endothelial Keratoplasty (DSEK)

This is a relatively new procedure.  Instead of replacing the entire cornea, only the back half—the endothelium and Decemet’s membrane—of the cornea is replaced.  There are both advantages to both DSEK and penetrating transplants, which your ophthalmologist should discuss with you prior to surgery.

The DSEK operation involves surgically removing Descemet’s membrane and the endothelium from the patient’s cornea.  An incision is made in the patient’s eye, and the back half of a donor cornea (Descemet’s membrane plus endothelium) is inserted into the eye.  By manipulating the donor cornea in special ways, the surgeon can firmly attach the donor cornea to the patient’s cornea within a few minutes without the use of stitches (sutures).

video of corneal transplantVideo of DSEK Procedure

Advantages of DSEK over PK include:
Lack of sutures.
Less chance of astigmatism.
Decreased healing time. 
Decreased risk of infection. 
Decreased risk of rupture.
        Disadvantages include: 
Final vision may not be as clear as with a PK.
Greater chance of early post-operative complications.

> Make an appointment with a corneal specialist at the Wilmer Eye Institute.

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