The association of Fuchs's corneal endothelial dystrophy with axial hypermetropia, shallow anterior chamber, and angle closure glaucoma

Abstract

A series of 24 patients with Fuchs's dystrophy are presented in whom detailed clinical measurement showed an association with axial hypermetropia and shallow anterior chamber. In 14 of these patients one cornea had developed oedema, of which 11 had required penetrating keratoplasty. Comparison of these eyes with the fellow eyes without corneal oedema revealed that the anomalies in measurement were not due to the process of decompensation. These 14 patients were then compared with the remaining 10 patients without corneal oedema in either eye, and a similar profile of anomalous measurements was observed. The whole group of 24 patients were then compared with three separate control groups, and in each case a significant trend towards hypermetropia, short axial length, and shallow anterior chamber was noted. The mean spherical equivalent refractive error in the patients with Fuchs's dystrophy was +2.48 D compared with -0.31 D for controls; corresponding means for axial length were 22.1 mm compared with 23.4 mm; and for anterior chamber depth were 2.2 mm compared with 2.7 mm. Each of these differences was statistically significant, but there was no significant difference for the keratometry measurements between patients and controls. Five of 24 (21%) of the patients had problems related to shallow anterior chambers of whom 3 (12%) had manifest angle closure glaucoma requiring surgical peripheral iridectomy. The aetiology of Fuchs's dystrophy and of ametropia is discussed and possible modes of association outlined. This previously unrecognised association gives a rational basis for the widely accepted practice of combining penetrating keratoplasty with lens extraction and has several other practical implications which are important in the differential diagnosis and treatment of Fuchs's dystrophy and angle closure glaucoma.