A historical perspective on treatment of fuchs' endothelial dystrophy: We have come a long way

Abstract

Fuchs' endothelial corneal dystrophy is a hereditary and progressive vision-threatening disease with a high prevalence in our adult population. In the past two decades, endothelial transplantation has dramatically changed the way we treat these patients. Back then, our limited surgical techniques often resulted in less than ideal outcomes. It was unimaginable for our patients to achieve near perfect visual acuity in such a short span of time. Over the years, we have tenaciously refined our surgical techniques to vastly improve patient outcomes, and with the recent advent of Rho-kinase inhibitors, we may even consider delivering a simple injection to our patients in the future. Our purpose is to take a historical perspective on how far we have come in treating this disorder and how rapidly this field will continue to evolve.

Regenerative medicine in Fuchs' endothelial corneal dystrophy

“…In particular, the management of corneal endothelial disorders has rapidly evolved over the last two decades with the advent of endothelial keratoplasty (EK), credited largely to the pioneering work of Melles, Terry, and Gorovoy, who since 1998 have successively introduced posterior lamellar keratoplasty, deep lamellar EK, Descemet's stripping (automated) EK (DSAEK), and Descemet's membrane EK (DMEK). [ 2 ] While each iteration refined the technique to strive for improved outcomes, EK is fundamentally based on the idea that replacement of endothelium with donor tissue is necessary because corneal endothelium does not have the regenerative capacity to repopulate the central cornea, and therefore, contact between donor endothelium and a denuded host posterior stroma is required to restore transparency.…”

Evaluating Keratoplasty for Fuchs’ Endothelial Corneal Dystrophy: A Literature Review

“…but not yet routinely available in the UK, nor currently approved in the US for this context) [1,11]. ROCK is the downstream effector of RhoA, a GTPase protein that is a member of the Ras family [13]. This RhoA/ROCK pathway allows regulation of cell migration, proliferation, and apoptosis and has thus been a great point of interest in treating endothelial diseases, particularly in early-stage dysfunction [13,17].…”

“…Factors that may contribute to graft failure incorporate: graft rejection (prophylactic topical steroid drops are usually required), infection, and glaucoma [ 1 , 7 ]. Furthermore, even if the graft remains clear, vision does not always improve after PK, especially because of astigmatism; hence, correction of the latter via surgery or suture manipulation may be necessary [ 7 , 13 ].…”

“…Vision can take time to stabilise, and glasses or contact lenses may be used to improve visual outcomes post-operatively [ 1 , 13 ]. Overall, although PK is often successful and can restore vision despite advanced FECD, patients might undergo a relatively delayed recovery [ 1 , 13 ].…”

Failed Descemet Stripping Only (DSO) with Adjuvant Rho-Kinase Inhibitor Therapy in a Fuchsʼ Endothelial Dystrophy Patient: A Case Report

“…Most corneal transplants worldwide are performed due to this dystrophy [2]. The technique of Descemet stripping only (DSO)also called descemetorhexis without endothelial keratoplasty (DWEK)was proposed in 2018 as a new therapeutic option for Fuchsʼ dystrophy [3,4]. In contrast to lamellar keratoplasty (Descemet Stripping Automated Endothelial Keratoplasty [DSAEK]/Descemet Membrane Endothelial Keratoplasty [DMEK]), DSO does not involve keratoplasty after peeling off the central endothelium.…”