Fuch's Corneal Dystrophy

Q.    What is Fuch's Dystrophy?

Fuch's dystrophy is a disease of the cornea in which the inner lining of the cornea (endothelium) changes structure and function and results in swelling, pain and loss of vision.  Although the cause of Fuch's dystrophy is unknown, there is a hereditary component (dominant trait, mostly affecting females) and the disease usually starts in the patient's 40s and progresses over the course of 25 years or so.   Usually both eyes are affected and early in the disease process there is the formation of "drop-like" particles on the endothelium in the absence of swelling.  In the middle portion of the disease there is corneal swelling, in which the cornea thickens to about twice its normal thickness, and the patient experiences halos around lights, glare problems and blurred vision.  The patient may complain of a foreign body sensation in the eyes, small corneal ulcers or blisters and pain.  The final stage of the disease process involves the further deterioration of the cornea, significantly reduced vision and possible growth of blood vessels in the side of the cornea, although the pain sensation decreases.  Treatment sometimes starts with techniques to dry-out the cornea as well as the decreasing of the humidity in the environment, lubricants, occlusion or/and a soft contact lens bandage.  Finally, penetrating keratoplasty is usually the treatment that provides the most relief for the patient.  In penetrating keratoplasty a large section of the cornea is transplanted.

Yes.  Applied research into the exact topic that you discuss is being carried-out at the Ohio State University by Dr. Cindy Roberts in the Department of Ophthalmology (Ph: 614-293-70399).  The research is being funded by the Ohio LIONS Eye Research Foundation.  Not only is Dr. Roberts doing the research into corneal topography and corneal transplants, but in collaboration with corneal surgeons they're using the new techniques to perform the corneal surgery and to prevent the very issue that you raise.   In a nut shell, the research/surgical team removes and replaces the cornea in advanced cases of keratoconus, for example, and when the new cornea is sutured into place Dr. Roberts does a corneal topography scan of the corneal surface to detect any irregular/abnormal areas during the surgery.  If so, the surgeon is advised to adjust the sutures in question - another scan is performed, etc., until everything looks fine.  Doing the corneal topography scans in the operating room while the surgery is being performed reduces the potential for complications afterwards.  Please note: e-mail inquiries via the present web site are anonymous; we have no way to reply directly to your e-mail request since we do not record the address of the e-mail sender.  For more information about Fuch's dystrophy go to Fuch's.

No.  Because Fuch's dystrophy involves a problem with the corneal  edothelium and basement membrane, PTK would not help in Fuch's.  PTK, almost identical to PRK (photorefractive keratectomy) but without the concern for changing refractive error, is limited to the epithelium - the front most part of the cornea.  As to your second question, Waring et al (1997, J. Refractive Surgery May - June Issue, p308-310) published a case report on PTK and Fuch's dystrophy and stated "A 63 year old female with Fuch's ...was inappropriately treated with [PTK], leading to a central focal circular corneal scar and decreased visual acuity that required penetrating keratoplasty" (cornea transplant).

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