Fuchs Endothelial Dystrophy Follow-up

  • Author: Daljit Singh, MBBS, MS, DSc; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 17, 2012
 

Further Inpatient Care

  • If additional surgery is needed to treat various complications of Fuchs endothelial dystrophy that can arise, further inpatient care may be required.
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Further Outpatient Care

  • Perform routine checkups to assess vision, fundus, and intraocular tension.
  • Examine the condition of the graft every 15 days to look for a sign of graft rejection.
  • Remove sutures at the following postoperative visits: interrupted sutures (starting 2-3 mo), running sutures (after 12 mo), and interrupted sutures (selectively remove until the astigmatism is less than 3 diopters).
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Inpatient & Outpatient Medications

  • Administer oral acetazolamide as needed to control intraocular pressure (IOP).
  • Prednisolone acetate 1% drops instilled 8 times per day, tapering gradually to bid for 4-8 weeks and qd for several months. After this time, fluorometholone drops 0.25% are given for 1-2 years.
  • If an epithelial defect is present, topical antibiotic drops or ointment are used 4-6 times per day.
  • For patients with deficient tear secretion, use artificial tears 6-8 times per day.
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Transfer

  • Because the surgery is performed on elderly patients who are sometimes frail and who may have multiple health problems (eg, cardiovascular, respiratory, renal, cerebral systems), be prepared at all times to transfer the patient to an appropriate institution, as and when the need arises.
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Deterrence/Prevention

  • Protecting the eye
    • Patients should avoid rubbing and bumping the eye.
    • Patients should use a protective shield at night and protective glasses during the day for at least 3 months, and ideally longer, after surgery.
    • Patients should avoid splashing the eye with tap water when taking a bath.
  • Patients should observe the following cleanliness guidelines:
  • Avoid cleaning the eye with nonsterile products.
  • Avoid applying cosmetics on the lid margin.
  • Avoid smoke and dusty environment.
  • Avoid putting any drops, other than prescribed drops, in the eye.
  • Do not touch the nozzle of the eye drop bottle during use. Store the medicine bottle in a cool place, preferably inside a refrigerator.
  • Patients should beware of warning signs; seek urgent consultation if any of the following warning signs occur:
    • Feeling of heaviness and pain
    • Redness of the eye, especially around the cornea
    • Diminution of eyesight
    • Light sensitivity
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Complications

  • Expulsive hemorrhage
  • Wound separation and aqueous leakage
  • Glaucoma
  • Endophthalmitis
  • Loose sutures, suture track infection
  • Cataract formation
  • Infective keratitis
  • Epithelial healing problems and ulceration
  • Graft rejection and failure
  • Vitreoretinal problems - Cystoid macular edema, choroidal detachment, and retinal detachment
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Prognosis

  • As a result of a successful corneal graft, patients experience complete freedom from bullae formation, pain, and irritation.
  • A high percentage of patients will have excellent transparency of the graft.
  • If the host cornea is not vascularized, the chances of graft rejection are minimized.
  • If the crystalline lens is transparent and the macular function is good, the chance of the patient regaining excellent vision is great.
  • Secondary procedures may be necessary to minimize astigmatism and any gross refractive error.
  • If the cornea has been vascularized as a result of repeated erosions and ulcer formation, the long-term results are less predictable.
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Patient Education

  • As long as the vision is good for practical purposes, with or without local medication, surgery is not needed.
  • If a patient develops a cataract, that patient will need cataract surgery with or without keratoplasty. The surgeon in consultation with the patient will make the final decision.
  • This corneal condition needs a long-term, close interaction between the patient and the ophthalmologist.
  • The less affected eye needs as much attention as the affected eye.
  • Since the condition can be familial, other members of the family should have an eye examination.
  • A regular balanced diet and exercise are as useful to the body as they are to the eye.
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Contributor Information and Disclosures
Author

Daljit Singh, MBBS, MS, DSc  Professor Emeritis, Department of Ophthalmology, Guru Nanak Dev University, Amritsar, India; Director, Daljit Singh Eye Hospital

Daljit Singh, MBBS, MS, DSc is a member of the following medical societies: All India Ophthalmological Society, American Society of Cataract and Refractive Surgery, Indian Medical Association, International Intraocular Implant Club, and Intraocular Implant and Refractive Society, India

Disclosure: Nothing to disclose.

Coauthor(s)

Vikas Mittal, MBBS, MS  Medical Director and Consultant Cornea Surgeon, Sanjivni Eye Care, India

Vikas Mittal, MBBS, MS is a member of the following medical societies: All India Ophthalmological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Ravijit Singh, MD, to the development and writing of this article.

References

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Familial Fuchs endothelial dystrophy in a 65-year-old female. The other eye presented similarly. Her father and older brother were reported to have the same malady.
The left eye of a 75-year-old man showing fully developed Fuchs endothelial dystrophy. The optical section shows marked thickening of the central part of the cornea and lifting up of the epithelium. Bullae formation is seen on the nasal side. The epithelium is thickened.
Close-up view of the limbal area of the same patient as in Media file 2. It clearly shows thickening of the epithelium, bullae formation, and vascularization of the cornea.
An optical section through the right cornea of the same patient as in Media file 3. It shows edema of the cornea and severe endothelial changes. The endothelial cell count in this eye was 800 cells/mm2.
Severe cornea guttata in a 61-year-old woman. The endothelium is speckled with pigment. This patient had complained of mistiness in her otherwise excellent vision.
Slit lamp examination under high magnification of a 54-year-old man, showing severe cornea guttata. The cornea illuminated by retroillumination from the edge of the slit light on the iris resembles dewdrops.
Pseudoguttata produced by uveal inflammation. Corneal edema is also present. The other eye was normal. These "guttata" disappeared completely under treatment.
Specular endothelial microscopy in a case of severe cornea guttata with transparent cornea. The guttata lesions have affected many individual cells and groups of cells.
Corneal edema in the eye of a 67-year-old woman.
 
 
 
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