Fuchs Endothelial Dystrophy Follow-up
- Author: Daljit Singh, MBBS, MS, DSc; Chief Editor: Hampton Roy, Sr, MD more...
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).
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.
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.
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.
Eye protection measures include the following:
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
See the list below:
Wound separation and aqueous leakage
Loose sutures, suture track infection
Epithelial healing problems and ulceration
Graft rejection and failure
Vitreoretinal problems - Cystoid macular edema, choroidal detachment, and retinal detachment
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.
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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