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W W W . C O R N E A . O R G

An explanation of the condition and your treatment options

Fuchs’ Dystrophy and DMEK

The Cornea Research Foundation of

America was founded as a non-profit

organization in 1988 by Francis W. Price,

Jr., MD with a mission to give people back

the use of their eyes.

Today, through countless research studies

and in partnership with Price Vision

Group and its skilled surgeons, we’re

making that mission a reality.

Meet Price Vision Group Surgeons:

Francis W. Price, Jr., MD An internationally recognized ophthalmic surgeon, named one of the top physicians in the country for corneal disease and transplantation

by The Best Doctors in America.

Yuri McKee, MD A Board Certified Ophthalmic Surgeon with fellowship training in corneal transplant surgery from the renowned Emory Eye Center. Dr. McKee focuses his practice on complex

surgeries of the cornea, iris and lens.

Matthew T. Feng, MD A magna cum laude graduate of Harvard who was a Dean’s Merit Scholar at the University of Pittsburgh School of Medicine and also a

Presidential Scholar representing Pennsylvania.

Fuchs’ endothelial corneal dystrophy (Fuchs’) is a hereditary eye disease with symptoms that often become noticeable after the age of 50. Ultimately, it causes loss in vision which can be treated with a cornea transplant. To understand Fuchs’ you must first understand how the cornea works, since Fuchs’ initially only affects one single layer of the cornea. The cornea is the clear window on the front of the eye and is comprised of three main layers—the epithelium, stroma and endothelium.

Fuchs’ dystrophy and Treatment

The purpose of the epithelium is to act as a barrier to

protect the cornea from dust, debris and bacteria. The

stroma is the middle layer and makes up 90% of

cornea thickness, mostly of collagen and other

structural materials. Its purpose is to give the cornea its

strength and dome-like shape. The endothelium is just

one layer of cells located on the Descemet membrane

(blue line in illustration above) and its job is to provide

the appropriate balance of fluid in the cornea, keeping

it thin and crystal clear.

In patients with Fuchs’, the endothelial cells slowly

deteriorate as tiny bumps called guttae accumulate on

the Descemet’s membrane (photos in middle column).

When this happens, the surrounding cells become

damaged and cannot work. Since the remaining cells

cannot keep up with pumping fluid, the cornea begins

swelling (known as corneal edema). As a result, the

cornea becomes thicker and cloudy, resulting in vision

problems. In advanced cases, tiny blisters can form on

the surface of your cornea which can be painful, so it is

important to seek treatment prior to severe progression.

A list of symptoms may be found to the right.

Once you find that your vision is impairing your quality

of life or causing you to cut back on activities, such as

night driving, it is time to replace the diseased layer.

Fortunately, we now have a minimally invasive way to

do that with a transplant procedure known as DMEK.

LAYERS OF THE CORNEA

Glare and sensitivity to light Poor vision upon awakening with

improvement later in the day Eye pain Foggy or blurred vision Seeing colored halos around lights Difficulty seeing at night

In the past, there was just one option for transplants, called penetrating keratoplasty

(PK) (figure A), which involves the surgical removal of the central two-thirds of the

damaged cornea. It is then replaced with healthy donor tissue. The new tissue is held

in place typically by 16 sutures. This full thickness transplant has the potential to

provide clear vision after healing, however, the healing time can be upwards of a year

and in some cases, the sutures may never be removed. The recipient must be careful

with the eye to ensure the wound doesn’t rupture, even many years after a transplant.

Since 20 percent of PK grafts reject, many patients require more than one surgery.

To give you better vision and faster recovery, the Cornea Research Foundation

has been working since 2001, to pioneer a new option called endothelial keratoplasty.

We have found that you can get the best possible vision and fastest recovery with a

variation known as Decemet’s Membrane Endothelial Keratoplasty (DMEK) (figure

B), which studies have shown provides optimal visual results with less adverse risks

than with PK. The cornea is the thickness of a credit card, and DMEK replaces less

than 1/20th of that thickness. With DMEK, only the damaged endothelium of the

cornea is replaced (figure C). This tissue (see Layers of the Cornea) is carefully

removed through a small incision, and the replacement donor tissue is rolled up,

inserted and flattened out. Rather than sutures, the tissue is held in place with an air

bubble, resulting in faster healing.

Notice the anterior surface of the cornea remains intact with

DMEK which leaves the eye much stronger and less prone to

injury and the eye appears healthier just 7 days after surgery

(figures A and B, compared), all significant improvements over

PK. Visual recovery is also much faster with DMEK because the

air bubble that holds the tissue in place while it attaches is much less traumatic than sutures. In some cases,

patients may experience visual acuity as good as 20/20 just a few days after surgery with glasses. Most

importantly, the rejection risk is 15 to 20 times lower with DMEK. Such low rejection is unprecedented and

essentially eliminates one the main reason that transplants fail. In summary, research has shown that DMEK is

now an excellent treatment option for patients with Fuchs’ dystrophy.

These two images show endothelial cells, the cells that make up the endothelium layer of the cornea. The image on the left depicts a healthy endothelium where hexagonal cells are clearly outlined. The image on the right shows an eye

with guttae, which would be diagnosed as Fuchs dystrophy.

Figure A: PK

TREATMENT: Cornea Transplants—what’s right for you?

Figure B: DMEK

Figure C: DMEK

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Arrow represents

DMEK tissue thickness

SYMPTOMS WHAT DOES FUCHS’ LOOK LIKE?

Guttae