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This is one of the problems affecting clear vision. In the case of Fuchs' endothelial dystrophy, the cornea becomes misty and reduces the power of sight. It's a disease of the eye that progresses. If you have Fuchs', when you look at things they appear to be covered in fog. It's like a look through your car's windshield on a stormy day; you may not be able to see the vehicles ahead of you except for their backlights which may even not be clear enough.
Fully described as Fuchs' endothelial dystrophy, this condition presents itself as a progressive disease where the cornea gets misty, and patients eventually see less with their eyes. When this disease strikes, the endothelial cells in the cornea are affected. How? Endothelial cells are a special single layer of cells located behind the cornea, whose work is to remove water from it. When these cells are in good health, they ensure the cornea stays thin and transparent. However, since they cannot grow again if damaged, unhealthy endothelial cells cannot protect the cornea, and this allows water to fill in. Eventually, it swells, becomes fuzzy and causes poor vision.
Clear and bright is the perfect description of a healthy cornea. But in a severe case of Fuchs' dystrophy, the cornea gets fuzzy and unclear as a result of swelling. This impacts the way you see objects. The usual signs of this eye disorder include:
A hazy vision especially during the early hours of the morning
An optician or opthalmologist can identify early symptoms of Fuchs' in patients, including those in their 30s. Still, it is not common for symptoms to show up in patients such that they will need surgery until they get to their 50s.
Would you like to get treated for foggy or poor vision? Please make arrangements to visit our clinic for a consultation today.
Age can be a reason for the endothelial cells reduction; this is a regular occurrence. Newborn babies are born with about 4000 endothelial cells per square millimetre. On the other hand, an adult aged 80 and without Fuchs' dystrophy typically has between 1500 to 2000 endothelial cells for each square millimetre. But in a patient with Fuchs' dystrophy, there is a rapid loss of cells. This is so significant that an adult of 50 years may not have up to 500 cells in a square of a millimetre.
Again, people with Fuchs' dystrophy possess abnormal endothelial cells that can store up abnormal proteins which could cause small bumps behind the cornea known as guttata.
Unusual genes affecting the proper functioning of endothelial cells do cause Fuchs' dystrophy, but this relationship has not been clearly established. Different generations of one family can experience Fuchs' dystrophy, and it can also show up rapidly in cases where there is no family history of the disease. People may not always inherit the gene for Fuchs' dystrophy as it changes in transmission. This means that if a parent has Fuchs' dystrophy, their offspring will not always carry the disease.
At the initial phase of this condition, the cornea swelling may still be less serious. Here, the doctor's prescription may be sodium chloride (table salt) ointment or drops. This approach lies on osmosis - the saltier the tears, the more water is pumped out of the cornea.
Unfortunately, the salt ointment is not a treatment for Fuchs' dystrophy and in early cases, it will slow down the need for a surgery.
Surgery for Fuchs' dystrophy has to do with transplanting endothelial cells that are healthy to take the place of dead or damaged cells --- a surgical procedure known as endothelial transplantation. Cataract surgery may also be used together with this treatment. The highest standard of corneal transplantation for treating Fuchs' dystrophy is the endothelial keratoplasty (DMEK or DSAEK surgery).
Before now, Fuchs' dystrophy was corrected with full-thickness corneal transplantation (PK), but this approach is no more considered modern.
So, let's look at what the surgical procedures involve.
DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty) Endothelial Transplantation Surgery. This surgical operation has to do with bringing a layer of donor corneal tissue usually very thin (replacement tissue) having a thickness of one-tenth of a millimetre along with endothelial cells that are healthy and passing them through small openings into the front part of the eye. The recent endothelial cell layer is moved towards the top until it reaches the back end of the cornea. The surgeon will proceed to position an air bubble at the back of the graft tissue, and pressure is applied to it to keep it in place. Stitches are not used to adhere the graft. Post-surgery, some air remains inside the eye, and you will be asked to lie on your back for a minimum of 1 hour such that the air bubble will keep assisting the new layer of the cornea in place. This entire operation can be done under general or local anaesthetic.
DMEK (Descemet's Membrane Endothelial Keratoplasty) endothelial transplants. Here, the damaged endothelium is taken out and replaced with a sheet of healthy endothelial cells having a thickness of a hundredth of a millimetre from a donor. The main selling point of DMEK over DSAEK is a faster recovery time and a rejection rate of less than one percent. Please note that DMEK surgery may not be suitable for everyone. Your surgeon will tell you more about this. This operation can be carried out under local or general anaesthetic.
Corneal failure can happen if patients having Fuchs'dystrophy undergo regular cataract surgery. However, this can be avoided if special care and changes are made to the standard method of surgery. This will reduce the damage to the corneal endothelial cell (soft shell technique). The ideal pattern is to have a corneal surgeon who has experience treating people with Fuchs' dystrophy carry out the surgical operation.
Certain persons may opt for femtosecond laser cataract surgery as it lowers the level of energy utilised in the excision of cataract, and lows damage to the endothelial cells. Where the Fuchs' dystrophy is a moderate to advanced one, the surgeon may choose to carry out both cataract surgery and corneal endothelial transplantation simultaneously.
Via specular microscopy, endothelial cell numbers can be evaluated before the operation. The essence of this is to know if only cataract surgery should be done, or together with DSAEK or DMEK.
With an excellent collaboration between our team members and surgeons, we have been able to achieve a success rate in discharging over 5% of corneal transplant surgery. Not only that, we have given several patients who have undergone corneal transplant the best form of care. This makes us stand out as one of the best surgical corneal centres in London.
DMEK and DSAEK are not surgical operations for amateurs. They both require special skills and experience that only an up-to-date surgeon can provide. It might interest you to know that even here in Europe, just 1 in every 4 surgeons is capable of undertaking this operation. Before this time, Fuchs' dystrophy patients required a full-thickness corneal transplant (penetrating keratoplasty) - a procedure that takes a long time for patients to recover.
We have surgeons who are DMEK and DSAEK experts. So you don't have anything to worry about when it comes to this treatment.
That said, there are other aspects of our practice you need to know because we are positioned to deliver precise treatment for all kinds of eye issues.
See for yourself, other features that makes us tick and why you should choose us for Fuchs' dystrophy:
Knowing the danger of surgery from poorly experienced surgeons, we encourage you to seek the best in the industry. We are happy to say that we have carefully selected and retained only dedicated and highly successful surgeons with a heart for treating patients optimally at our practice.
Our surgeons have received the best training at the best centres in London and around the world. So, we have the requisite experience, knowledge, and skills to perform this operation successfully. Holding their heads high in excellent training for cornea, refractive, and cataract surgery, our surgeons have a very high level of surgical skills.
At the helm of operations at our practice are well-trained consultants with decades of experience in pterygium surgery. We pride in our ability to give the best form of eye treatment depending on what your case requires. Patients get customised treatment plans for specific needs, followed by great care and support after treatment.
Laser eye surgery and lens surgery are done using the latest technology and tools in the industry. Same goes for pterygium surgery. We have all that's needed to perform a painless and effective tissue excision to bring back the health of your eye. What we do at Optimal Vision is to combine the best optical technology with the best hands in surgery to repair any damage that has been done to the eye. It's a painstaking effort, but we do it because we are passionate about delivering only one thing - excellent eye care services!
You can visit our central clinic in London for eye treatment. We are available all the time for your eye treatment.
If it is not possible for you to come in person to our clinic, you can get our professional help via video consultation. This is available for both patients who are insured and those paying from their pocket. Just like your normal video call, you will get to speak with our surgeon to know more about your eye condition.
We offer a 0% finance*** for patients who need any of our eye surgical treatments. With this, you can pay more conveniently by spreading payment over a number of months if required.
Are you interested in Fuchs' dystrophy surgery for improved vision? Feel free to book an appointment with us anytime soon.
Dr Mani has performed more than 20,000 ophthalmic procedures, including LASIK, LASEK, PRK, Femto Cataract, RLE, Lens ICL and Phakic IOL Surgery
I had a great experience performing my laser eye surgery at Optimal Vision Clinic. All the staffs are very helpful, co-operative and supportive throughout the treatment process. On the first call, they explained the entire procedure in details and gave necessary instructions at every stage. My eye surgeon made me feel comfortable and relaxed before and during the procedure. Aftercare was done properly with a thorough check-up of my eyes. I would like to recommend this clinic to everyone!
Very happy and impressed with the highly professional care and service I’ve received at the Optimal Vision clinic. Dr Mani is so professional, and he explained everything about Laser surgery and answered all my questions. The surgery was quick and almost completely painless. My eyes have healed perfectly and quickly. I would highly recommend this clinic.
My husband had been experiencing discomfort in his left eye since July and was seen by various doctors/consultants even at the Queen Mary’s hospital but no abnormalities were found.
This week Dr. Mani discovered the fault which happened to be Retina detachment with three tears.
Dr. Mani’s preciseness and his perfectionist attitude to attention to details, detected the source of the main issue and saved my husband’s eye. We feel utterly grateful and can not recommend him enough for his excellence.
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