Review of the Literature: Surgery Indications for Fuchs' Endothelial Corneal Dystrophy

Abstract

Objectives: To provide an overview of the preoperative indications for endothelial graft in patients with Fuchs endothelial corneal dystrophy (FECD). Methods: A comprehensive database search without date restrictions was performed in PubMed. Keywords included Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), corneal keratoplasty, preoperative visual acuity, preoperative central corneal thickness, and densitometry. Articles aiming to describe or evaluate preoperative indications for endothelial keratoplasty were considered eligible and were included in this review. Results: The indications for surgery in FECD are disparate between the different studies. The tendency is to operate on patients earlier to obtain a better postoperative visual acuity at 1 year. The surgical decision is based on a number of arguments (visual acuity, CCT, densitometry). A preoperative visual acuity worse than 20/40 is generally considered a surgical indication for DMEK, based on current literature. Conclusions: Surgical decisions for Fuchs' dystrophy should be individualized, guided by preoperative visual acuity, corneal OCT, and advanced imaging, with future risk scores potentially refining the timing of intervention to optimize outcomes.

Keywords: DMEK; DSAEK; Fuchs’s dystrophy; SD-OCT; preoperative acuity.

Figure 1

Spectral-Domain Optical Coherence Tomography view of the different types of endothelial grafts. Horizontal cross-sections of the corneal apex. (A) DMEK (graft thickness not measurable: posterior hyperreflective line (endothelo-Descemet’s membrane) < 15 µm); (B) nanothin DSAEK (15 < graft thickness < 50 µm); (C) ultrathin DSAEK (50 ≤ graft thickness < 100 µm); (D) DSAEK (graft thickness ≥ 100 µm). The yellow horizontal line represents the reference axis along which the thickness of the endothelial graft and the adjacent host cornea were assessed on cross-sectional OCT images. Source: Georgeon C., Tourabaly M.

Figure 2

Tomographic characteristics with Scheimpflug’s technique of a subclinical corneal edema.

Figure 3

Specular microscopy of the different stages of cornea guttata (Laing’s classification).