Fuch’s dystrophy is a condition that some people are born with that can slowly progress as time goes on. It does tend to run in families but not all family members will necessarily be affected. The cornea is the clear front cover of the eye and it is responsible for focusing light. There is a layer of cells that line the inner surface of the cornea whose job it is to pump water out of the cornea and prevent swelling. Everyone is born with a certain number of these cells and each year some of these cells are lost. There are enough of these cells to start with that by the time one reaches older age, there will be enough remaining to do their job. People with Fuch’s dystrophy loose these cells at a faster rate than normal so that long before they reach old age, there are not enough cells remaining to keep water from accumulating in the cornea and swelling results, causing blurred vision.
Typically, people with Fuch’s dystrophy will have blurred vision that is worse upon awakening and which slowly gets better as the day goes on. As the condition progresses, the time it takes for the cornea to clear becomes longer until the vision remains blurred all day. There are some drops that can help to reduce the swelling and speed up the time it takes the vision to clear in the morning. These can help for some time but eventually the Fuch’s can progress beyond the point where drops can help and in these cases, surgical intervention can help.
Surgical correction requires a corneal transplant. Corneal tissue from a donor is used to replace the layer of poorly functioning endothelial cells with healthy ones that can provide better vision. In the past, the only treatment was a full thickness transplant, called a penetrating keratoplasty or PK, which replaced the entire central cornea. A corneal transplan takes about 30 minutes and is done as an outpatient. It often takes 6-12 months to heal and stabilize to the point that glasses can be prescribed. This can restore vision to near normal.
In the past few years a new technique called DSEK, or DSAEK, has been developed in which only the very inner layer of the cornea is replaced. This type of corneal transplant also takes about 30 minutes and is done as an outpatient. In contrast to a full thickness transplant, the healing time is about 6-8 weeks. Although not everyone is a good candidate for this more limited surgery it is becoming the most common surgical treatment for Fuch’s dystrophy.
Dr. John Meyer is our corneal surgeon at the Eye Care Institute. After his three year ophthalmology residency at Saint Louis University, he completed a one year fellowship training dedicated to corneal transplant surgery at Emory University Since 1995 he has been performing corneal transplants as well as other specialized corneal surgery and regularly sees patients on referral from local and regional ophthalmologists with complicated and difficult to treat conditions. If you yourself, or someone you know has a corneal problem, Dr. Meyer would be happy to help with evaluation, treatment or give another opinion.