Fuchs’ Dystrophy

Fuchs Dystrophy Corneal Transplants Icon by Brisbane Ophthalmologist Dr David Gunn.

What is Fuchs’ Dystrophy?

Fuchs’ dystrophy is an eye condition where the front window of the eye (called the cornea) becomes cloudy. It is a progressive condition meaning it tends to get worse with time. Early on you may be told you have Fuchs’ but have no symptoms. This may progress to having trouble with glare or hazy vision particularly in low light. The contrast in the vision may be poor or you may have trouble driving at night. Later in the disease you may notice badly blurred vision on first waking in the morning that clears over the day. Usually Fuchs’ does not cause any symptoms until after the age of forty.

Why is the cornea cloudy in Fuchs’ Dystrophy?

The cornea on the front of the eye should normally be a clear dome to allow light to pass into the eye. Water inside the eye is always trying to soak into this front window. There are water pump cells called “endothelium” on the back surface of the cornea that are constantly fighting this swelling pressure. In Fuchs’, there is progressive loss of these pump cells. Eventually, those that remain are unable to keep the cornea dry. This can happen naturally or can be brought on after eye surgery such as cataract surgery. Once the cornea fills with water, it starts to go hazy which blurs the vision and when severely swollen can develop blisters on the surface than can give stinging eye pain.

Fuchs' Dystrophy in elderly male patient.

How is Fuchs’ detected?

Your optometrist or ophthalmologist will see the classic sign which is a beaten metal appearance on the back of the cornea called “guttata”. Late in the disease they will be able to see the cornea is swollen and waterlogged.

Why did I get Fuchs’ Dystrophy?

There is a genetic basis for Fuchs’. In many patients there is a family history while in others it may be “sporadic” (meaning there is no family history).

How is Fuchs’ Dystrophy treated?

Many patients with Fuchs’ are completely unaware that they have it. Only at the time of cataract surgery is it brought up as an issue. If the disease is early and mild, routine cataract surgery is safe. If however the disease is more advanced, combining cataract surgery with a corneal graft is the recommended treatment. If the cornea fails after cataract surgery or the visual quality is still very poor, a corneal graft is the treatment. In Fuchs’ the latest and most effective corneal graft is known as a “DMEK” (Descemet’s Membrane Endothelial Keratoplasty). This procedure involves removing the failed pump cells and replacing them “like for like” with a sheet of pump cells from a donor cornea.

Why should I see Dr Gunn for my Fuchs’ Dystrophy?

Dr Gunn is a corneal sub-specialist and is internationally trained specifically in the most modern treatment for Fuchs’ Dystrophy - DMEK surgery. This surgery provides faster visual recovery and better vision than the older DSEK graft technique (Descemet’s Stripping Endothelial Keratoplasty) which uses a graft 8-10x thicker. A recent review performed by the American Academy of Ophthalmology assessed the literature available comparing DMEK to the older DSEK treatment. Its conclusions were:

“The evidence reviewed supports DMEK as a safe and effective treatment for endothelial failure. With respect to visual recovery time, visual outcomes, and rejection rates, DMEK seems to be superior to DSEK and to induce less refractive error with similar surgical risks and EC loss compared with DSEK...” - Ophthalmology. 2018 Feb;125(2):295-310.

What is the recovery period like following DMEK?

You will need to take at least 1-2 weeks off work for your surgery, sometimes up to a month depending on what you do. Vision will initially be very blurred but generally following DMEK the vision improves very rapidly over a number of days. You will need to use eye drops for an extended period after a corneal graft. You will need to attend follow up appointments for Dr Gunn to check on your graft and eye health. There are usually around 6 appointments in the first year with 6 to 12 monthly visits following that.