Materiały źródłowe

• #1 Fuchs’ Endothelial Dystrophy – EyeWiki

  https://eyewiki.org/Fuchs%E2%80%99_Endothelial_Dystrophy

  Fuchs dystrophy is an inherited corneal dystrophy affecting the endothelium. There is no primary prevention for this disease entity. […] The diagnosis of Fuchs’ Endothelial Dystrophy is primary clinical, based on history and slit lamp exam of the eye. […] The classic history for Fuchs endothelial dystrophy is a patient, more commonly a woman, in the fourth to fifth decade of life, with symptoms of reduced or fluctuating vision, glare, or in some cases recurrent foreign body sensation. […] The diagnosis of Fuchs endothelial dystrophy is clinical. The diagnosis is relatively easy in early disease as you can see the endothelial changes as well as mild corneal stromal edema. In severe cases, where you cannot see the endothelium, the diagnosis can be more challenging, and the diagnosis may need to be based on the contralateral eye or by history.

• #2 Fuchs’ Dystrophy: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23438-fuchs-dystrophy

  Fuchs dystrophy is an eye disease that affects your corneas. […] Depending on how severe it is, your provider may recommend a corneal transplant. […] Your provider will be able to see things in your eye exam that will point to a diagnosis of Fuchs dystrophy. These include: thickening of certain membranes, changes in the way your endothelium looks, bumps called guttae on the inside of your cornea. […] Your provider may use the following tests to diagnose Fuchs dystrophy: microscopy, pachymetry, optical coherence tomography. […] A healthcare provider can treat Fuchs endothelial dystrophy, but they cant cure it. […] When Fuchs starts to limit your vision, surgery is the definitive treatment. […] Its important to develop a good relationship with your eye care specialist. […] Theres currently no way to prevent Fuchs corneal dystrophy. […] If you do have symptoms like pain or blurred vision, see a healthcare provider as soon as possible.

• #3 Fuchs dystrophy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fuchs-dystrophy/diagnosis-treatment/drc-20352731

  An eye care professional will test your vision. You also may have tests to help diagnose Fuchs dystrophy. Those tests may include: […] A member of your eye care team will use a special eye microscope called a slit lamp to look for drop-shaped bumps called guttae on the back surface of the cornea. This eye care professional will then check your cornea for swelling and stage your Fuchs dystrophy. […] An eye care professional may use a test called corneal pachymetry to measure the thickness of the cornea. […] Taking a special picture of your cornea helps an eye care professional look for swelling in your cornea. This test is called corneal tomography. […] Sometimes an eye care professional uses a special instrument to record the number, shape and size of the cells that line the back of the cornea. This test is not required. […] For Fuchs dystrophy, questions to ask include: What tests do I need?

• #4 Fuchs’ Dystrophy – Clinical Services – Robert Cizik Eye Doctors Clinic

  https://www.cizikeyedoctors.org/clinical-services/fuchs-dystrophy

  Besides testing your vision, your doctor will examine and grade your cornea with a slit lamp. The thickness of your cornea may be measured, and special pictures may be taken to look for signs of swelling in the cornea. Your doctor may also examine the size, shape and count of the cells that line the back of the cornea. With those details, your doctor can determine the stage of the disease and develop the best treatment plan.

• #5

  https://www.aao.org/eye-health/diseases/what-is-fuchs-dystrophy

  Fuchs’ Diagnosis Your ophthalmologist will look closely at your cornea and measure its thickness. This is called pachymetry. They will also check for tiny blisters on the front surface of the cornea and drop-like bumps of the back surface of the cornea (guttae). Using a special photograph of your cornea, your ophthalmologist may count your endothelial cells. […] There is no cure for Fuchs dystrophy. However, you can control vision problems from corneal swelling. Your treatment depends on how Fuchs dystrophy affects your eyes cells.

• #6 Diagnosis and Treatment

  https://eye.hms.harvard.edu/book/export/html/1805626

  Fuchs dystrophy can often be diagnosed with slit-lamp biomicroscopy, which illuminates the layers of the cornea to identify disease characteristics such as the extent of corneal guttae formation, corneal edema, and subepithelial haze. […] Other tests may include: Visual acuity measurement Pachymetry to measure the extent of corneal swelling Specular and confocal microscopies to quantify the corneal endothelial cell number and morphology Corneal topography to identify curvature changes due to edema.

• #7 Fuchs Endothelial Corneal Dystrophy: From One Medical Student to Another

  https://eyerounds.org/tutorials/fuchs-endothelial-corneal-dystrophy-med-student/index.htm

  Fuchs Endothelial Corneal Dystrophy (FECD) is a corneal dystrophy affecting primarily the deepest layer of the cornea, known as the corneal endothelium. It is the most common corneal dystrophy, affecting 4% of the American population over the age of 40, and is the most common indication for corneal transplantation in the US. […] The Krachmer grading scale can be used to classify severity of FECD and track progression of the disease. Grading is based on the characterization of guttae on slit lamp examination. […] Early symptoms of FECD may include blurry or hazy vision in the morning that improves throughout the day. […] Pachymeters utilize ultrasound energy in order to measure central corneal thickness. While FECD is a clinical diagnosis, pachymetry is both supportive in the diagnosis and useful for tracking disease progression, as the cornea will progressively thicken as more endothelial cells are lost and the stroma becomes more edematous.

• #8 The Optometrist’s Guide to Fuchs Endothelial Corneal Dystrophy – Modern Optometry

  https://modernod.com/articles/2024-oct/the-optometrists-guide-to-fuchs-endothelial-corneal-dystrophy

  Fuchs endothelial corneal dystrophy (FECD) is a genetic condition that most commonly affects women and typically develops in the sixth decade of life. […] The hallmark finding of FECD is central corneal guttae, which are small excrescences of Descemet membrane secondary to endothelial cell death that can be seen on imaging. […] Central bilateral cornea guttae are pathognomonic for FECD. These can be visualized with the slit-lamp technique of specular reflection. […] Specular microscopy can also help detect FECD by imaging the endothelial cells. […] Serial pachymetry is also helpful in monitoring FECD progression into the later stages of the disease. […] Patients diagnosed with FECD should be educated about its hereditary nature and their family members monitored for it.

• #9 Fuchs’ Endothelial Dystrophy – EyeWiki

  https://eyewiki.org/Fuchs%E2%80%99_Endothelial_Dystrophy

  The diagnosis of Fuchs endothelial dystrophy is clinical; however, there are some diagnostic tests that can be helpful. Pachymetry, or measurement of the central corneal thickness, is helpful in following a patient with Fuchs dystrophy. […] Fuchs endothelial dystrophy is diagnosed clinically. Specular microscopy to visualize the endothelium can corroborate the typical endothelial changes associated with this dystrophy.

• #10

  https://umiamihealth.org/en/bascom-palmer-eye-institute/specialties/corneal-and-external-diseases/fuchs%E2%80%99-dystrophy

  Eye Pressure Test – After numbing your eyes with special drops, your eye doctor quickly touches your eyes with an instrument that measures eye pressure. […] Corneal Thickness – Using an optical instrument, your doctor measures the thickness of your cornea. […] Corneal Cell Count – The quantity, size and shape of your corneal cells are measured with a special instrument.

• #11 Automated diagnosis and staging of Fuchs’ endothelial cell corneal dystrophy using deep learning | Eye and Vision | Full Text

  https://eandv.biomedcentral.com/articles/10.1186/s40662-020-00209-z

  To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs endothelial corneal dystrophy (FECD) without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography (HD-OCT). […] FECD can be diagnosed using slit lamp examination, specular microscopy, corneal thickness measurement, and confocal microscopy. However, these tools are incapable of monitoring the chronological changes of the disease or predicting its progression, especially after cataract extraction. […] Recently, pachymetry maps and posterior corneal curvature patterns generated with Scheimpflug tomography have been reported to facilitate the identification of subclinical edema in cases with FECD. […] Currently, with the advent of anterior segment optical coherence tomography (AS-OCT), it has become credible to perform non-contact in vivo imaging to evaluate the corneal microstructure of FECD cases at a quasi-histologic level. […] This study is the first that presents a deep learning approach to automatically discriminate healthy corneas from early and late FECD disease. Here, we report that our deep learning algorithm can be used as a potential objective diagnostic tool for grading the severity of FECD.

• #12 Fuchs’ Dystrophy | Your Eye Health

  https://www.guidedogs.org.uk/getting-support/information-and-advice/eye-conditions/fuchs-dystrophy/

  Fuchs’ dystrophy can be diagnosed by closely examining the back layer of the cornea. Your optician may do the following tests to diagnose Fuchs’ dystrophy: […] Use a slit lamp to examine your eye and look for irregular bumps (guttae) at the back of the cornea. […] Measure the corneal thickness with a corneal pachymetry test. […] Take a photograph of the cornea (called tomography). […] An optician can refer you to an ophthalmologist if you need help with symptoms.

• #13 Fuchs Endothelial Corneal Dystrophy: From One Medical Student to Another

  https://eyerounds.org/tutorials/fuchs-endothelial-corneal-dystrophy-med-student/index.htm

  Fuchs Endothelial Corneal Dystrophy (FECD) is a corneal dystrophy affecting primarily the deepest layer of the cornea, known as the corneal endothelium. It is the most common corneal dystrophy, affecting 4% of the American population over the age of 40, and is the most common indication for corneal transplantation in the US. […] The Krachmer grading scale can be used to classify severity of FECD and track progression of the disease. Grading is based on the characterization of guttae on slit lamp examination. […] Early symptoms of FECD may include blurry or hazy vision in the morning that improves throughout the day. […] Pachymeters utilize ultrasound energy in order to measure central corneal thickness. While FECD is a clinical diagnosis, pachymetry is both supportive in the diagnosis and useful for tracking disease progression, as the cornea will progressively thicken as more endothelial cells are lost and the stroma becomes more edematous.

• #14 Fuchs dystrophy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fuchs-dystrophy/diagnosis-treatment/drc-20352731

  An eye care professional will test your vision. You also may have tests to help diagnose Fuchs dystrophy. Those tests may include: […] A member of your eye care team will use a special eye microscope called a slit lamp to look for drop-shaped bumps called guttae on the back surface of the cornea. This eye care professional will then check your cornea for swelling and stage your Fuchs dystrophy. […] An eye care professional may use a test called corneal pachymetry to measure the thickness of the cornea. […] Taking a special picture of your cornea helps an eye care professional look for swelling in your cornea. This test is called corneal tomography. […] Sometimes an eye care professional uses a special instrument to record the number, shape and size of the cells that line the back of the cornea. This test is not required. […] For Fuchs dystrophy, questions to ask include: What tests do I need?

• #15 Managing Fuchs Dystrophy: From Diagnosis To Treatment And Beyond

  https://www.my-iclinic.co.uk/articles/managing-fuchs-dystrophy-from-diagnosis-to-treatment

  Diagnosing Fuchs dystrophy typically involves a comprehensive eye examination and specialised tests to assess the health and function of the cornea. Here are the steps involved in diagnosing Fuchs dystrophy: […] By performing these tests and examinations, ophthalmologists can accurately diagnose Fuchs dystrophy and develop an appropriate treatment plan tailored to the individual needs of the patient. […] One notable area of progress lies in the realm of diagnostics. Advanced imaging modalities, such as anterior segment optical coherence tomography (AS-OCT) and corneal topography, offer detailed insights into corneal morphology and endothelial cell function. These non-invasive techniques enable clinicians to assess disease severity, monitor progression, and tailor treatment strategies with unprecedented precision.

• #16 Automated diagnosis and staging of Fuchs’ endothelial cell corneal dystrophy using deep learning

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7460770/

  To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs endothelial corneal dystrophy (FECD) without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography (HD-OCT). […] FECD can be diagnosed using slit lamp examination, specular microscopy, corneal thickness measurement, and confocal microscopy. However, these tools are incapable of monitoring the chronological changes of the disease or predicting its progression, especially after cataract extraction. […] Recently, pachymetry maps and posterior corneal curvature patterns generated with Scheimpflug tomography have been reported to facilitate the identification of subclinical edema in cases with FECD. […] Currently, with the advent of anterior segment optical coherence tomography (AS-OCT), it has become credible to perform non-contact in vivo imaging to evaluate the corneal microstructure of FECD cases at a quasi-histologic level.

• #17 Applications of Imaging Technologies in Fuchs Endothelial Corneal Dystrophy: A Narrative Literature Review

  https://www.mdpi.com/2306-5354/11/3/271

  Fuchs endothelial corneal dystrophy (FECD) is a complex genetic disorder characterized by the slow and progressive degeneration of corneal endothelial cells. Thus, it may result in corneal endothelial decompensation and irreversible corneal edema. […] Hence, anterior segment imaging devices that enable precise measurement of functional and anatomical changes in the cornea are essential for the management of FECD. In this review, the authors will introduce studies on the application of various imaging modalities, such as anterior segment optical coherence tomography, Scheimpflug corneal tomography, specular microscopy, in vitro confocal microscopy, and retroillumination photography, in the diagnosis and monitoring of FECD and discuss the results of these studies. […] Therefore, imaging devices that can enable visualization and precise assessment of corneal layers, particularly corneal endothelium, are critical for the diagnosis and management of FECD. Advances in technology have led to the development of anterior segment imaging modalities that can be useful for the monitoring of FECD, such as anterior segment optical coherence tomography (AS-OCT), Scheimpflug corneal tomography, specular microscopy, and in vitro confocal microscopy.

• #18 Fuchs’ dystrophy

  https://www.mymlc.com/health-information/diseases-and-conditions/f/fuchs-dystrophy2/?section=Risk%20factors

  Fuchs’ dystrophy is usually inherited. The genetic basis of the disease is complex — family members can be affected to varying degrees or not at all. […] Besides testing your vision, your doctor might also have you undergo the following tests to determine whether you have Fuchs’ dystrophy: Cornea examination and grading. Your doctor will make the diagnosis of Fuchs’ dystrophy by examining your eye with an optical microscope (slit lamp) to look for irregular bumps (guttae) on the inside surface of the cornea. He or she will then assess your cornea for swelling and stage your condition. […] Your doctor might use a test called corneal pachymetry to measure the thickness of the cornea. […] Your doctor might obtain a special photograph of your cornea (tomography) to assess for early signs of swelling in your cornea. […] Sometimes your doctor might use a special instrument to record the number, shape and size of the cells that line the back of the cornea. However, this test is not required.

• #19 Fuchs dystrophy Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/fuchs-dystrophy

  Fuchs dystrophy can be inherited, which means it can be passed down from parents to children. If either of your parents has the disease, you have a 50% chance of developing the condition. […] An eye doctor can diagnose Fuchs dystrophy during a slit-lamp exam. […] Other tests that may be done include: Pachymetry — measures the thickness of the cornea, Specular microscope examination — allows the eye doctor to look at the thin layer of cells that line the back part of the cornea, Visual acuity test.

• #20 Fuchs’ Corneal Dystrophy Pensacola, Florida

  https://mcceyeinstitute.com/eye-conditions/fuchs-corneal-dystrophy/

  Fuchs dystrophy is an inherited condition that affects the delicate inner layer (endothelium) of the cornea. Patients with Fuchs dystrophy have endothelial cells that: […] Fuchs dystrophy is detected by examining the cornea with a slit lamp microscope that magnifies the endothelial cells thousands of times. The health of the endothelium is evaluated and monitored with pachymetry (which measures the thickness of the cornea) and specular microscopy (which photographs the cells for counting). As the dystrophy becomes more advanced, corneal clouding may make counting the cells impossible.

• #21 How Can an Ophthalmologist Diagnose Fuchs’ Dystrophy?

  https://abrahameye.com/how-can-an-ophthalmologist-diagnose-fuchs-dystrophy/

  Specular microscopy is a specialized imaging technique that allows ophthalmologists to visualize and analyze the structure of corneal endothelial cells. By examining the shape, size, and density of endothelial cells, ophthalmologists can identify abnormalities characteristic of Fuchs Dystrophy. Specular microscopy provides valuable insights into the health of the corneal endothelium and aids in diagnosing the disease. […] In addition to objective diagnostic tests, ophthalmologists consider clinical symptoms reported by the patient and their medical history when evaluating for Fuchs Dystrophy. Symptoms such as blurred or hazy vision, glare sensitivity, and discomfort upon waking can raise suspicion of the condition. Providing detailed information about your eye symptoms and family history is essential for an accurate diagnosis.

• #22 Fuchs Endothelial Dystrophy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20818

  Fuchs endothelial dystrophy (FED) is a bilateral, slowly progressive, and often asymmetric corneal disease characterized by endothelial cell deterioration and the development of guttata excrescences of the Descemet membrane. […] Diagnosis relies on clinical examination, imaging, and endothelial function assessment. Slit-lamp biomicroscopy reveals characteristic guttata in the central cornea, which initially appear as discrete excrescences and later coalesce into a more widespread „beaten metal” appearance. […] Specular microscopy is essential for confirming the diagnosis by assessing endothelial cell density (ECD), morphology, and pleomorphism. Normal ECD ranges from 2,500 to 3,000 cells/mm, but this value progressively declines in FED, with fewer than 1,000 cells/mm indicating moderate disease and fewer than 500 cells/mm suggesting severe endothelial failure.

• #23 Fuchs Endothelial Dystrophy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20818

  Fuchs endothelial dystrophy (FED) is a bilateral, slowly progressive, and often asymmetric corneal disease characterized by endothelial cell deterioration and the development of guttata excrescences of the Descemet membrane. […] Diagnosis relies on clinical examination, imaging, and endothelial function assessment. Slit-lamp biomicroscopy reveals characteristic guttata in the central cornea, which initially appear as discrete excrescences and later coalesce into a more widespread „beaten metal” appearance. […] Specular microscopy is essential for confirming the diagnosis by assessing endothelial cell density (ECD), morphology, and pleomorphism. Normal ECD ranges from 2,500 to 3,000 cells/mm, but this value progressively declines in FED, with fewer than 1,000 cells/mm indicating moderate disease and fewer than 500 cells/mm suggesting severe endothelial failure.

• #24 Fuchs’ Corneal Dystrophy Pensacola, Florida

  https://mcceyeinstitute.com/eye-conditions/fuchs-corneal-dystrophy/

  Fuchs dystrophy is an inherited condition that affects the delicate inner layer (endothelium) of the cornea. Patients with Fuchs dystrophy have endothelial cells that: […] Fuchs dystrophy is detected by examining the cornea with a slit lamp microscope that magnifies the endothelial cells thousands of times. The health of the endothelium is evaluated and monitored with pachymetry (which measures the thickness of the cornea) and specular microscopy (which photographs the cells for counting). As the dystrophy becomes more advanced, corneal clouding may make counting the cells impossible.

• #25 How Can an Ophthalmologist Diagnose Fuchs’ Dystrophy?

  https://abrahameye.com/how-can-an-ophthalmologist-diagnose-fuchs-dystrophy/

  Confocal microscopy is a high-resolution imaging technique that allows for detailed visualization of corneal structures at the cellular level. Ophthalmologists may utilize confocal microscopy to examine changes in corneal cells, detect early signs of Fuchs Dystrophy, and monitor disease progression with precision. […] After making an initial diagnosis of Fuchs Dystrophy, the next step is to determine the severity and prognosis of the condition. In more mild cases, simple over the counter medications may be used to manage the symptoms, whereas in more advanced stages, surgery or other interventions may be needed.

• #26 Applications of Imaging Technologies in Fuchs Endothelial Corneal Dystrophy: A Narrative Literature Review

  https://www.mdpi.com/2306-5354/11/3/271

  Specular microscopy is a non-invasive technique that allows for in vivo visualization of corneal endothelium by using specular reflection with slit-lamp biomicroscopy. […] IVCM is a non-invasive image acquisition technique that enables real-time analysis of all layers of the cornea at the histologic level. […] Retroillumination photography is an easy and simple method of obtaining images of the corneal endothelial layer with cameras attached to a slit lamp. […] In this review, we provided an overview of the application of various imaging technologies for the visualization and assessment of changes in the cornea in patients with FECD. Advances in anterior segment imaging technology have enabled precise and accurate evaluation of morphological and functional alterations in the cornea, even at a cellular level. Imaging techniques, including AS-OCT, Scheimpflug corneal tomography, specular microscopy, IVCM, and retroillumination photography, may improve the diagnostic performance and treatment outcome of FECD by providing detailed information regarding pathologic changes in the cornea caused by the disease.

• #27 Automated diagnosis and staging of Fuchs’ endothelial cell corneal dystrophy using deep learning

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7460770/

  To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs endothelial corneal dystrophy (FECD) without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography (HD-OCT). […] FECD can be diagnosed using slit lamp examination, specular microscopy, corneal thickness measurement, and confocal microscopy. However, these tools are incapable of monitoring the chronological changes of the disease or predicting its progression, especially after cataract extraction. […] Recently, pachymetry maps and posterior corneal curvature patterns generated with Scheimpflug tomography have been reported to facilitate the identification of subclinical edema in cases with FECD. […] Currently, with the advent of anterior segment optical coherence tomography (AS-OCT), it has become credible to perform non-contact in vivo imaging to evaluate the corneal microstructure of FECD cases at a quasi-histologic level.

• #28 A Review of the Management of Fuchs Endothelial Corneal Dystrophy – The Journal of Medical Optometry (JoMO)

  https://journalofmedicaloptometry.com/volume2-issue1/a-review-of-the-management-of-fuchs-endothelial-corneal-dystrophy/

  Various software programs are available to analyze the images and provide clinically useful indices: the cell density (CD) is measured in cells/mm,2 pleomorphism is measured by the hexagonal percentage (HEX), and polymegethism is measured by the coefficient of variation (CV). […] In advanced FECD, when the endothelial view is compromised by edema, in vivo confocal microscopy may be utilized. […] As FECD progresses, corneal thickness, polymegethism, and pleomorphism all increase. […] No current medical treatment can arrest the progression of FECD. […] Surgical decisions are based on signs and symptoms. […] Reduced visual acuity and the presence of corneal edema indicate corneal endothelial decompensation warrant surgical intervention. […] Traditionally, the only surgical option to treat FECD was PKP.

• #29 Fuchs dystrophy Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/fuchs-dystrophy

  Fuchs dystrophy can be inherited, which means it can be passed down from parents to children. If either of your parents has the disease, you have a 50% chance of developing the condition. […] An eye doctor can diagnose Fuchs dystrophy during a slit-lamp exam. […] Other tests that may be done include: Pachymetry — measures the thickness of the cornea, Specular microscope examination — allows the eye doctor to look at the thin layer of cells that line the back part of the cornea, Visual acuity test.

• #30 Diagnóstico de la distrofia endotelial de Fuchs | PortalCLÍNIC

  https://www.clinicbarcelona.org/en/assistance/diseases/fuchs-dystrophy/diagnosis

  Fuchs dystrophy is diagnosed using a slit lamp examination. […] Additional tests are: […] Pachymetry. This is a test to measure the thickness of the cornea. […] Specular microscopic examination This allows the ophthalmologist to see the thin layer of cells that line the back of the cornea. […] Visual acuity assessment.

• #31 EyeRounds.org: Fuchs endothelial dystrophy

  https://webeye.ophth.uiowa.edu/eyeforum/cases/case5.htm

  Fuchs Endothelial Dystrophy: […] The diagnosis is Fuchs endothelial dystrophy due to endothelial cell loss. Patients have worse vision in the morning because of the eyes being closed during the night causing a buildup of corneal edema (because the endothelium helps keep the cornea dry and clear). […] Diagnosis: Fuchs endothelial dystrophy […] Low endothelial cell counts on specular microscopy. […] Glare and blurred vision, typically worse in the morning due to corneal edema from lids being closed at night. […] Topical NaCl 5% drops 4X/day and ointment at night to help dehydrate the cornea. […] Caution with intraocular surgeries that may injure the corneal endothelium, e.g. cataract surgery. BSS(+) [with glutathione] may help reduce loss of endothelial cells during cataract surgery.

• #32 Fuchs’ Endothelial Dystrophy – EyeWiki

  https://eyewiki.org/Fuchs%E2%80%99_Endothelial_Dystrophy

  Fuchs dystrophy is an inherited corneal dystrophy affecting the endothelium. There is no primary prevention for this disease entity. […] The diagnosis of Fuchs’ Endothelial Dystrophy is primary clinical, based on history and slit lamp exam of the eye. […] The classic history for Fuchs endothelial dystrophy is a patient, more commonly a woman, in the fourth to fifth decade of life, with symptoms of reduced or fluctuating vision, glare, or in some cases recurrent foreign body sensation. […] The diagnosis of Fuchs endothelial dystrophy is clinical. The diagnosis is relatively easy in early disease as you can see the endothelial changes as well as mild corneal stromal edema. In severe cases, where you cannot see the endothelium, the diagnosis can be more challenging, and the diagnosis may need to be based on the contralateral eye or by history.

• #33 Fuchs’ dystrophy – Hello Doktor

  https://hellodoktor.com/en/fuchs-dystrophy/

  Fuchs dystrophy is diagnosed by an eye doctor called an ophthalmologist or optometrist. Theyll ask you questions about the symptoms youve been experiencing. During the exam, theyll examine your eyes to look for signs of changes in your cornea. […] Your doctor may also take a specialized photograph of your eyes. This is conducted to measure the amount of endothelium cells in the cornea. […] An eye pressure test may be used to rule out other eye diseases, such as glaucoma. […] Signs and symptoms of Fuchs dystrophy can be difficult to detect at first. As a rule of thumb, you should always see an eye doctor if you experience vision changes or discomfort in your eyes. […] If you wear contacts or eyeglasses, you should already see an eye doctor on a regular basis. Make a special appointment if you experience any possible symptoms of corneal dystrophy.

• #34 Fuchs’ Corneal Dystrophy: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/eye-health/fuchs-corneal-dystrophy

  Your doctor may first notice the disease during a routine eye exam when they use a special microscope called a slit lamp. This allows them to see the innermost layer of your cornea. They may also see small bumps on the underside of your cornea that are a telltale sign of Fuchs. […] Your doctor might check your eye pressure to rule out glaucoma, which raises eye pressure and can make you see halos. Then they’ll measure the thickness of your cornea.

• #35 EyeRounds.org: Fuchs endothelial dystrophy

  https://webeye.ophth.uiowa.edu/eyeforum/cases/case5.htm

  Fuchs Endothelial Dystrophy: […] The diagnosis is Fuchs endothelial dystrophy due to endothelial cell loss. Patients have worse vision in the morning because of the eyes being closed during the night causing a buildup of corneal edema (because the endothelium helps keep the cornea dry and clear). […] Diagnosis: Fuchs endothelial dystrophy […] Low endothelial cell counts on specular microscopy. […] Glare and blurred vision, typically worse in the morning due to corneal edema from lids being closed at night. […] Topical NaCl 5% drops 4X/day and ointment at night to help dehydrate the cornea. […] Caution with intraocular surgeries that may injure the corneal endothelium, e.g. cataract surgery. BSS(+) [with glutathione] may help reduce loss of endothelial cells during cataract surgery.

• #36 Fuch’s endothelial corneal dystrophy | RNIB

  https://www.rnib.org.uk/your-eyes/eye-conditions-az/fuchs-endothelial-corneal-dystrophy/

  One of the first symptoms you may notice, is your more blurred vision first thing in the morning when you wake up. […] Extra fluid in your cornea can make light uncomfortable and you may find it harder to see when it’s very bright. […] If your cornea is swollen, you may also develop blisters on its surface. […] If the changes to your sight are starting to cause difficulties in your day-to-day activities, your ophthalmologist may recommend that you have a corneal transplant. Corneal transplants can successfully treat FECD. […] The common types of corneal transplant procedures to treat FECD only replace the innermost layers of the cornea. […] Both endothelial keratoplasty and penetrating keratoplasty procedures work very well in FECD as the condition does not come back in the transplant. […] Corneal transplant is an effective treatment. However, sometimes a transplant may need to be repeated if there are problems with transplant rejection. […] If you are concerned about cataract surgery worsening FECD, it would be important to discuss this with your ophthalmologist.

• #37 Fuchs’ dystrophy – Wikipedia

  https://en.wikipedia.org/wiki/Fuchs%27_dystrophy

  Fuchs dystrophy is classified into 4 stages, from early signs of guttae formation to end-stage subepithelial scarring. Diagnosis is made by biomicroscopic examination in the clinic. Other modalities, such as corneal thickness measurement (pachymetry), in-vivo confocal biomicroscopy, and specular microscopy can be used in conjunction. […] The diagnosis of Fuchs dystrophy is often made with slit lamp biomicroscopy. With direct illumination, the clinician can visualize guttae, the characteristic pathological changes in disease. […] Scheimpflug imaging, anterior segment optical coherence tomography, confocal microscopy, and specular microscopy are additional imaging techniques that can identify the presence of guttae and quantify the thickness of the cornea. While corneal thickness can be a valuable indicator of how the cornea is changing over time, it is affected by multiple factors and is not adequate itself as a screening tool to diagnose Fuchs dystrophy.

• #38 Fuchs Endothelial Dystrophy: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1193591-overview

  Fuchs endothelial dystrophy (FED) is characterized by an asymmetrical, bilateral, slowly progressive edema of the cornea in elderly patients. When inherited, the transmission is autosomal dominant. Corneal endothelium is a monolayer of cells that acts as the major pump to deturgesce the cornea and ensures clarity. The normal attrition rate of endothelial cells is 0.6% per year; the rate is accelerated in Fuchs endothelial dystrophy. The root cause of the condition is a slowly progressive formation of guttate lesions between the corneal endothelium and the Descemet membrane. […] Cornea guttata may be discovered accidentally or when specular endothelial microscopy is performed to find out the cause of the visual disturbance. […] The patient usually has no complaints at this stage. Some very observant patients notice that the quality of their 20/20 vision is not the same as before. A slit lamp examination of the endothelium leads to the diagnosis.

• #39 Fuchs Endothelial Dystrophy: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1193591-overview

  Fuchs endothelial dystrophy (FED) is characterized by an asymmetrical, bilateral, slowly progressive edema of the cornea in elderly patients. When inherited, the transmission is autosomal dominant. Corneal endothelium is a monolayer of cells that acts as the major pump to deturgesce the cornea and ensures clarity. The normal attrition rate of endothelial cells is 0.6% per year; the rate is accelerated in Fuchs endothelial dystrophy. The root cause of the condition is a slowly progressive formation of guttate lesions between the corneal endothelium and the Descemet membrane. […] Cornea guttata may be discovered accidentally or when specular endothelial microscopy is performed to find out the cause of the visual disturbance. […] The patient usually has no complaints at this stage. Some very observant patients notice that the quality of their 20/20 vision is not the same as before. A slit lamp examination of the endothelium leads to the diagnosis.

• #40

  https://link.springer.com/article/10.1007/s40123-022-00637-1

  Corneal endothelium plays an important role in maintaining hydration homeostasis and clarity of the cornea. Fuchs endothelial corneal dystrophy (FECD) affects the corneal endothelium resulting in edema and characteristic excrescences on the Descemets membrane known as corneal guttae. The diagnosis of FECD is made primarily based on clinical findings and history. The progression of the disease is bilateral but may be asymmetric with four clinical stages over 2 to 3 decades. The first stage is characterized by the hallmark finding of non-confluent corneal guttae, which can be noted on slit-lamp examination. While it has been thought that patients generally have no complaints in the early stages, recent studies suggest that patients may have a lot of glare and color vision defects even in mild stages. The ability to combine the surgeries further raises important considerations regarding the timing and sequence of DMEK and cataract extraction for patients with FECD. Corneal surgeons factor in clinical history, examination, diagnostic tests (e.g., corneal tomography, specular and pachymetry), practice patterns and patient preference to make the decision of offering endothelial keratoplasty and cataract surgery alone, in combination or sequential. Diagnostic testing can be particularly helpful in evaluating patients without clinically evident edema by detecting subclinical edema and identifying eyes that would be higher risk for corneal decompensation. Typically, an endothelial cell density (ECD) of 500/mm2 is required to maintain corneal clarity, and eyes with EC counts 1000 are more likely to decompensate. However, the cell counts can be difficult to accurately measure in eyes with FECD, and cell counts do not adequately assess function. In a series of studies, Patel and colleagues have delineated tomographic findings on scheimpflug imaging that can be used to detect subclinical edema. Thus, the use of tomography can help predict which eyes may not benefit from cataract surgery alone or have a higher risk of needing EK in the future. For patients with both a visually significant cataract and FECD, either a DMEK triple procedure or a staged procedure can be considered. The DMEK triple procedure provides rapid visual recovery and limits the risks and costs associated with two separate procedures. A study looking at 203 eyes reported that the rates of graft dislocation after triple DMEK remain low with no graft failure at 6 months. Thus, the decision to perform a staged versus combined procedure should be based on surgeon experience.

• #41 Fuchs Endothelial Dystrophy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20818

  Pachymetry and anterior segment optical coherence tomography (AS-OCT) quantify corneal thickness and edema, aiding in disease staging. […] In FED, endothelial cells undergo apoptosis and lose their pump function, leading to excessive hydration of the corneal stroma and epithelium. […] Early-stage FED is often asymptomatic and detected only through slit-lamp examination, which reveals corneal guttata. […] As the disease advances, morning blurry vision becomes a hallmark symptom due to worsening corneal edema, which is exacerbated upon waking by reduced evaporation during sleep. […] Patients also report glare, halos, and difficulty with contrast sensitivity, particularly under low-light conditions. […] In moderate-stage disease, corneal thickening and endothelial dysfunction lead to persistent visual impairment throughout the day. […] Advanced-stage FED is marked by worsening stromal edema and the formation of painful epithelial bullae (bullous keratopathy), which can rupture and cause significant discomfort. […] If left untreated, chronic corneal decompensation results in irreversible fibrosis and scarring.

• #42 Fuchs Endothelial Dystrophy: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1193591-overview

  Slit lamp examination shows typical changes quite early. The posterior corneal lamellae are first to become edematous. They cause wrinkling in the Descemet membrane, termed striae. Epithelial edema is seen later. […] No medical treatment is known to prevent or stop the formation of cornea guttata. Hyperosmotic drops and ointment and bandage contact lenses may help for a time. Once the vision becomes adversely affected, a penetrating graft is advised at the convenience and the need of the patient. […] The chronicity of the disease leads to fibrovascular proliferation, followed by end-stage subepithelial scarring. This decreases the vision further. […] No known medical treatment prevents or stops the formation of cornea guttata. Hyperosmotic drops and ointment and bandage contact lenses may help temporarily. Once the vision becomes adversely affected, an endothelial graft is advised. Descemet membrane endothelial keratoplasty (DMEK) is the latest surgical technique for Fuchs endothelial dystrophy, and the results of this surgery are excellent in most cases.

• #43 Fuchs Endothelial Dystrophy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20818

  Pachymetry and anterior segment optical coherence tomography (AS-OCT) quantify corneal thickness and edema, aiding in disease staging. […] In FED, endothelial cells undergo apoptosis and lose their pump function, leading to excessive hydration of the corneal stroma and epithelium. […] Early-stage FED is often asymptomatic and detected only through slit-lamp examination, which reveals corneal guttata. […] As the disease advances, morning blurry vision becomes a hallmark symptom due to worsening corneal edema, which is exacerbated upon waking by reduced evaporation during sleep. […] Patients also report glare, halos, and difficulty with contrast sensitivity, particularly under low-light conditions. […] In moderate-stage disease, corneal thickening and endothelial dysfunction lead to persistent visual impairment throughout the day. […] Advanced-stage FED is marked by worsening stromal edema and the formation of painful epithelial bullae (bullous keratopathy), which can rupture and cause significant discomfort. […] If left untreated, chronic corneal decompensation results in irreversible fibrosis and scarring.

• #44 Living with Fuchs’ Dystrophy | Help & Support

  https://www.guidedogs.org.uk/getting-support/information-and-advice/eye-conditions/fuchs-dystrophy/living-with-fuchs-dystrophy/

  Adults in their 50s and 60s, particularly women, are more likely to be living with Fuchs’ dystrophy (also called Fuchs’ endothelial corneal dystrophy). […] As Fuchs’ dystrophy usually progresses slowly, many people won’t develop symptoms for years after diagnosis. […] Fuchs’ dystrophy is a corneal dystrophy that typically progresses slowly over decades. You’ll need regular eye exams so your optometrist can monitor your disease progression. […] At a later stage, blisters can develop on the outer layer of cells on the surface of the cornea (the epithelium). […] Life won’t change very much after the diagnosis of Fuchs’ dystrophy. You’ll have regular eye exams to monitor the condition and, if mild symptoms develop, taking eye drops may become part of your daily routine. […] If you develop severe symptoms, a corneal transplant is usually an option to improve your vision. However, if you have lasting symptoms, or a transplant is not successful, and you have significant vision loss, you may be considered to have a disability. […] Fuchs’ dystrophy generally progresses slowly, so although you may be diagnosed in your 30s or 40s, it can take 10 to 20 years for symptoms to develop and progress.

• #45 Fuchs Endothelial Dystrophy: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1193591-overview

  Slit lamp examination shows typical changes quite early. The posterior corneal lamellae are first to become edematous. They cause wrinkling in the Descemet membrane, termed striae. Epithelial edema is seen later. […] No medical treatment is known to prevent or stop the formation of cornea guttata. Hyperosmotic drops and ointment and bandage contact lenses may help for a time. Once the vision becomes adversely affected, a penetrating graft is advised at the convenience and the need of the patient. […] The chronicity of the disease leads to fibrovascular proliferation, followed by end-stage subepithelial scarring. This decreases the vision further. […] No known medical treatment prevents or stops the formation of cornea guttata. Hyperosmotic drops and ointment and bandage contact lenses may help temporarily. Once the vision becomes adversely affected, an endothelial graft is advised. Descemet membrane endothelial keratoplasty (DMEK) is the latest surgical technique for Fuchs endothelial dystrophy, and the results of this surgery are excellent in most cases.

• #46 Fuchs Endothelial Dystrophy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20818

  Pachymetry and anterior segment optical coherence tomography (AS-OCT) quantify corneal thickness and edema, aiding in disease staging. […] In FED, endothelial cells undergo apoptosis and lose their pump function, leading to excessive hydration of the corneal stroma and epithelium. […] Early-stage FED is often asymptomatic and detected only through slit-lamp examination, which reveals corneal guttata. […] As the disease advances, morning blurry vision becomes a hallmark symptom due to worsening corneal edema, which is exacerbated upon waking by reduced evaporation during sleep. […] Patients also report glare, halos, and difficulty with contrast sensitivity, particularly under low-light conditions. […] In moderate-stage disease, corneal thickening and endothelial dysfunction lead to persistent visual impairment throughout the day. […] Advanced-stage FED is marked by worsening stromal edema and the formation of painful epithelial bullae (bullous keratopathy), which can rupture and cause significant discomfort. […] If left untreated, chronic corneal decompensation results in irreversible fibrosis and scarring.

• #47 Living with Fuchs’ Dystrophy | Help & Support

  https://www.guidedogs.org.uk/getting-support/information-and-advice/eye-conditions/fuchs-dystrophy/living-with-fuchs-dystrophy/

  Adults in their 50s and 60s, particularly women, are more likely to be living with Fuchs’ dystrophy (also called Fuchs’ endothelial corneal dystrophy). […] As Fuchs’ dystrophy usually progresses slowly, many people won’t develop symptoms for years after diagnosis. […] Fuchs’ dystrophy is a corneal dystrophy that typically progresses slowly over decades. You’ll need regular eye exams so your optometrist can monitor your disease progression. […] At a later stage, blisters can develop on the outer layer of cells on the surface of the cornea (the epithelium). […] Life won’t change very much after the diagnosis of Fuchs’ dystrophy. You’ll have regular eye exams to monitor the condition and, if mild symptoms develop, taking eye drops may become part of your daily routine. […] If you develop severe symptoms, a corneal transplant is usually an option to improve your vision. However, if you have lasting symptoms, or a transplant is not successful, and you have significant vision loss, you may be considered to have a disability. […] Fuchs’ dystrophy generally progresses slowly, so although you may be diagnosed in your 30s or 40s, it can take 10 to 20 years for symptoms to develop and progress.

• #48 Fuchs Endothelial Dystrophy: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1193591-overview

  Slit lamp examination shows typical changes quite early. The posterior corneal lamellae are first to become edematous. They cause wrinkling in the Descemet membrane, termed striae. Epithelial edema is seen later. […] No medical treatment is known to prevent or stop the formation of cornea guttata. Hyperosmotic drops and ointment and bandage contact lenses may help for a time. Once the vision becomes adversely affected, a penetrating graft is advised at the convenience and the need of the patient. […] The chronicity of the disease leads to fibrovascular proliferation, followed by end-stage subepithelial scarring. This decreases the vision further. […] No known medical treatment prevents or stops the formation of cornea guttata. Hyperosmotic drops and ointment and bandage contact lenses may help temporarily. Once the vision becomes adversely affected, an endothelial graft is advised. Descemet membrane endothelial keratoplasty (DMEK) is the latest surgical technique for Fuchs endothelial dystrophy, and the results of this surgery are excellent in most cases.

• #49 Fuchs Endothelial Dystrophy | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20818

  Pachymetry and anterior segment optical coherence tomography (AS-OCT) quantify corneal thickness and edema, aiding in disease staging. […] In FED, endothelial cells undergo apoptosis and lose their pump function, leading to excessive hydration of the corneal stroma and epithelium. […] Early-stage FED is often asymptomatic and detected only through slit-lamp examination, which reveals corneal guttata. […] As the disease advances, morning blurry vision becomes a hallmark symptom due to worsening corneal edema, which is exacerbated upon waking by reduced evaporation during sleep. […] Patients also report glare, halos, and difficulty with contrast sensitivity, particularly under low-light conditions. […] In moderate-stage disease, corneal thickening and endothelial dysfunction lead to persistent visual impairment throughout the day. […] Advanced-stage FED is marked by worsening stromal edema and the formation of painful epithelial bullae (bullous keratopathy), which can rupture and cause significant discomfort. […] If left untreated, chronic corneal decompensation results in irreversible fibrosis and scarring.

• #50 An Introduction to Fuchs’ Dystrophy for Patients | The Corneal Dystrophy Foundation

  https://www.cornealdystrophyfoundation.org/an-introduction-to-fuchs-dystrophy-for-patients/

  Fuchs Dystrophy can be a distressing diagnosis but, thankfully, it is not a medical emergency. […] Once Fuchs causes noticeable changes to the cornea, it can feel as if the disease developed all of a sudden, even though this is not what happened. […] The easiest way is to consult your corneal specialist and ask them specifically about whether any conditions that are not Fuchs Dystrophy are contributing to your symptoms. […] Currently available eye drops treat the corneal swelling caused by Fuchs but not the diseased endothelial cells that cause the swelling. […] DMEK (Descemet Membrane Endothelial Keratoplasty) is currently the most advanced surgical treatment available for Fuchs, but you should also be aware of other corneal transplant surgeries that came before DMEK. […] The primary structural difference between DMEK, DSAEK, and PK relates to which layers of the cornea are transplanted.

• #51 Understanding Your Fuchs’ Endothelial Dystrophy Diagnosis: Stephen Khachikian, MD: Ophthalmologist

  https://www.stevekmd.com/blog/understanding-your-fuchs-endothelial-dystrophy-diagnosis

  Receiving a Fuchs endothelial dystrophy diagnosis can feel overwhelming, but understanding the condition a cornea problem and its progression is the first step toward managing your eye health. […] He can help you understand the diseases early symptoms, spot the warning signs of progression, and develop a personalized treatment plan that preserves your vision. […] While Fuchs endothelial dystrophy currently has no cure, you can effectively manage the condition. […] If youve recently received a diagnosis, Dr. Khachikian can offer treatment options tailored to your needs.

• #52 Reddit – The heart of the internet

  https://www.reddit.com/r/CataractSurgery/comments/1hcros0/important_have_your_eyes_checked_for_fuchs/

  „I think you have Fuch’s dystrophy. This is a progressive disease that you have probably had for years but weren’t aware of it.” […] „It’s best to diagnose Fuch’s prior to cataract surgery because it can affect which lenses are best for you and the surgical technique is modified to reduce cornea damage.” […] „Although progression can’t be stopped, it can be slowed. You want to catch Fuch’s early to slow down the damage with medication.” […] „With Fuch’s disease, the absolute WORST IOL to select is one that reduces light level and contrast (typically, multifocals).” […] „With Fuch’s, every surgery to the cornea makes the condition worse.” […] „The key is to catch it BEFORE this point so that progression can be slowed and appropriate decisions made around IOL selection in the future.” […] „I am highly suggesting that you request your optometrist, opthalmologist and cataract surgeon to check for Fuch’s dystrophy prior to your cataract surgery.”

• #53

  https://link.springer.com/article/10.1007/s40123-022-00637-1

  Corneal endothelium plays an important role in maintaining hydration homeostasis and clarity of the cornea. Fuchs endothelial corneal dystrophy (FECD) affects the corneal endothelium resulting in edema and characteristic excrescences on the Descemets membrane known as corneal guttae. The diagnosis of FECD is made primarily based on clinical findings and history. The progression of the disease is bilateral but may be asymmetric with four clinical stages over 2 to 3 decades. The first stage is characterized by the hallmark finding of non-confluent corneal guttae, which can be noted on slit-lamp examination. While it has been thought that patients generally have no complaints in the early stages, recent studies suggest that patients may have a lot of glare and color vision defects even in mild stages. The ability to combine the surgeries further raises important considerations regarding the timing and sequence of DMEK and cataract extraction for patients with FECD. Corneal surgeons factor in clinical history, examination, diagnostic tests (e.g., corneal tomography, specular and pachymetry), practice patterns and patient preference to make the decision of offering endothelial keratoplasty and cataract surgery alone, in combination or sequential. Diagnostic testing can be particularly helpful in evaluating patients without clinically evident edema by detecting subclinical edema and identifying eyes that would be higher risk for corneal decompensation. Typically, an endothelial cell density (ECD) of 500/mm2 is required to maintain corneal clarity, and eyes with EC counts 1000 are more likely to decompensate. However, the cell counts can be difficult to accurately measure in eyes with FECD, and cell counts do not adequately assess function. In a series of studies, Patel and colleagues have delineated tomographic findings on scheimpflug imaging that can be used to detect subclinical edema. Thus, the use of tomography can help predict which eyes may not benefit from cataract surgery alone or have a higher risk of needing EK in the future. For patients with both a visually significant cataract and FECD, either a DMEK triple procedure or a staged procedure can be considered. The DMEK triple procedure provides rapid visual recovery and limits the risks and costs associated with two separate procedures. A study looking at 203 eyes reported that the rates of graft dislocation after triple DMEK remain low with no graft failure at 6 months. Thus, the decision to perform a staged versus combined procedure should be based on surgeon experience.

• #54 Fuchs Dystrophy – Northeast Wisconsin Vision Center

  https://newvisioncenter.com/eye-conditions/fuchs-dystrophy/

  Fuchs dystrophy is a common disease of the cornea. […] Often people become aware of the condition when discussing cataract surgery with their eye surgeon. The reason is that cataract surgery can make the Fuchs dystrophy worse. […] The treatments for Fuchs dystrophy include using a salt-solution eye drops or a cornea transplant. […] For more significant cases, the only solution is a cornea transplant. […] Dr. Larson and Dr. Raven are cornea specialists and take care of many patients with Fuchs dystrophy. They regularly perform cornea transplants and are available for a consultation at N.E.W. Vision Center.

• #55 Managing Fuchs Dystrophy: From Diagnosis To Treatment And Beyond

  https://www.my-iclinic.co.uk/articles/managing-fuchs-dystrophy-from-diagnosis-to-treatment

  Moreover, AI-driven algorithms hold promise in enhancing diagnostic accuracy and prognostic capabilities. Machine learning algorithms trained on large datasets of corneal images can assist clinicians in early detection of Fuchs dystrophy, predicting disease progression, and optimising treatment outcomes.

• #56 Automated diagnosis and staging of Fuchs’ endothelial cell corneal dystrophy using deep learning

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7460770/

  Our findings showed excellent discrimination between healthy, early-stage FECD and late-stage FECD confirmed by the high accuracy, sensitivity and specificity in diagnosing the 3 classes. […] The results of this study highlight the potential utility of deep learning models in identifying early FECD, based on one AS-OCT scan without additional imaging modalities (e.g., Pachymetry, specular microscopy, confocal microscopy) or other information. […] This is the first study that presents a deep learning approach to automatically discriminate healthy corneas from early and late FECD disease. The present results may serve as a benchmark for deep-learning-based approach to accurately distinguish normal corneas and cases with guttae but no edema from FECD cases, from the very mild or subclinical edema.

• #57 Automated diagnosis and staging of Fuchs’ endothelial cell corneal dystrophy using deep learning

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7460770/

  Our findings showed excellent discrimination between healthy, early-stage FECD and late-stage FECD confirmed by the high accuracy, sensitivity and specificity in diagnosing the 3 classes. […] The results of this study highlight the potential utility of deep learning models in identifying early FECD, based on one AS-OCT scan without additional imaging modalities (e.g., Pachymetry, specular microscopy, confocal microscopy) or other information. […] This is the first study that presents a deep learning approach to automatically discriminate healthy corneas from early and late FECD disease. The present results may serve as a benchmark for deep-learning-based approach to accurately distinguish normal corneas and cases with guttae but no edema from FECD cases, from the very mild or subclinical edema.

• #58 Automated diagnosis and staging of Fuchs’ endothelial cell corneal dystrophy using deep learning | Eye and Vision | Full Text

  https://eandv.biomedcentral.com/articles/10.1186/s40662-020-00209-z

  To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs endothelial corneal dystrophy (FECD) without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography (HD-OCT). […] FECD can be diagnosed using slit lamp examination, specular microscopy, corneal thickness measurement, and confocal microscopy. However, these tools are incapable of monitoring the chronological changes of the disease or predicting its progression, especially after cataract extraction. […] Recently, pachymetry maps and posterior corneal curvature patterns generated with Scheimpflug tomography have been reported to facilitate the identification of subclinical edema in cases with FECD. […] Currently, with the advent of anterior segment optical coherence tomography (AS-OCT), it has become credible to perform non-contact in vivo imaging to evaluate the corneal microstructure of FECD cases at a quasi-histologic level. […] This study is the first that presents a deep learning approach to automatically discriminate healthy corneas from early and late FECD disease. Here, we report that our deep learning algorithm can be used as a potential objective diagnostic tool for grading the severity of FECD.

• #59 Applications of Imaging Technologies in Fuchs Endothelial Corneal Dystrophy: A Narrative Literature Review

  https://www.mdpi.com/2306-5354/11/3/271

  In this narrative review, we aim to provide an overview of the application of anterior segment imaging technology in FECD and discuss the potential future development of these modalities with advancements in imaging processing technology and artificial intelligence (AI). […] AS-OCT can be a valuable tool for the assessment of attachment of endothelial graft after DSAEK or DMEK, which may be important for decision-making regarding re-attachment procedures in the early postoperative period. […] The application of AI in the interpretation of AS-OCT images may improve the detection and management of FECD. […] However, AS-OCT is not yet capable of imaging the corneal endothelium at a cellular level or determining the morphology and density of the corneal endothelial cells. […] Scheimpflug corneal tomography has emerged as a valuable tool for the diagnosis and monitoring of FECD.

• #60 Fuchs’ Endothelial Corneal Dystrophy evaluation using a high-resolution wavefront sensor | Scientific Reports

  https://www.nature.com/articles/s41598-024-71480-6

  This study aims to evaluate the applicability of the high-resolution WaveFront Phase Imaging Sensor (WFPI) in eyes with Fuchs Endothelial Corneal Dystrophy (FECD) through qualitative and quantitative analysis using a custom-designed Automatic Guttae Detection Method (AGDM). […] The usual exploration of this disease is performed using the slit-lamp to evaluate the status of the cornea (the presence of guttae, bullae, or corneal scarring). […] Several authors expressed the relevance of a quantitative observation of guttae distribution due to its benefit in the diagnosis and prognostic purposes, the effect of guttae on the quality of vision, and determining surgical indications for endothelial surgery in eyes with mild FECD. […] The aim of this work is to objectively evaluate the applicability of the mentioned sensor using a custom-designed Automatic Guttae Detection Method (AGDM) capable of distinguishing between healthy and pathological eyes with FECD using phase information (concretely using the high-pass filter map).

• #61 Fuchs’ Endothelial Corneal Dystrophy evaluation using a high-resolution wavefront sensor | Scientific Reports

  https://www.nature.com/articles/s41598-024-71480-6

  The metric Number of Guttae Detected increments when the pupil diameter increases, but the metric Guttae Density does not change in the Healthy group, indicating that in this group the regions detected are not dependent of the pupil diameter while in the FECD group the value was slightly decreased due to the highest concentration of guttae in the central region that tends to spread toward the periphery. […] The usability of the automatic method is supported by the number of metrics that are easy to interpret and are distinguishable between healthy and pathological eyes. […] In summary, the objective quantification of guttae is an important prerequisite for the Fuchs Dystrophy assessment and treatment, and it would allow a better understanding of the origin of visual impairment. […] A reliable objective analysis of the guttae could be performed with an automatic detection method, being a valid tool for the diagnosis and monitoring of the pathology over time.

• #62 How Can an Ophthalmologist Diagnose Fuchs’ Dystrophy?

  https://abrahameye.com/how-can-an-ophthalmologist-diagnose-fuchs-dystrophy/

  Fuchs Dystrophy is a progressive eye condition that affects the cornea, leading to cloudy vision and discomfort. When it comes to diagnosing Fuchs Dystrophy, ophthalmologists employ a range of specialized techniques and examinations to assess the health of the cornea and determine the presence and severity of the disease. With a combination of physical examination and special testing, an ophthalmologist is able to both diagnose and treat Fuchs Dystrophy properly. […] Diagnosing Fuchs Dystrophy typically begins with a comprehensive eye examination conducted by an ophthalmologist. During this exam, the ophthalmologist will assess various aspects of eye health, including visual acuity, intraocular pressure, and the condition of the cornea. Any signs of corneal abnormalities or reduced vision may prompt further evaluation for Fuchs Dystrophy.

• #63 How Can an Ophthalmologist Diagnose Fuchs’ Dystrophy?

  https://abrahameye.com/how-can-an-ophthalmologist-diagnose-fuchs-dystrophy/

  A crucial aspect of diagnosing Fuchs Dystrophy involves a detailed evaluation of the cornea, the clear front surface of the eye. Ophthalmologists may employ techniques such as slit-lamp biomicroscopy to examine the corneas thickness, shape, and clarity. Changes in corneal thickness and the presence of corneal guttatatiny bumps on the corneal surfaceare indicative of Fuchs Dystrophy. […] In cases of suspected Fuchs Dystrophy, ophthalmologists may perform an endothelial cell count to assess the health and functionality of the corneal endothelium. The corneal endothelium is a thin layer of cells responsible for maintaining corneal transparency. A reduced endothelial cell count or abnormal cell morphology can suggest the presence of Fuchs Dystrophy. […] Corneal pachymetry is another diagnostic tool used to measure the thickness of the cornea. In Fuchs Dystrophy, corneal thickening may occur due to fluid buildup in the corneal stroma. By evaluating corneal thickness using pachymetry, ophthalmologists can assess changes associated with the disease and monitor disease progression over time.

• #64 Living with Fuchs’ Dystrophy | Help & Support

  https://www.guidedogs.org.uk/getting-support/information-and-advice/eye-conditions/fuchs-dystrophy/living-with-fuchs-dystrophy/

  Adults in their 50s and 60s, particularly women, are more likely to be living with Fuchs’ dystrophy (also called Fuchs’ endothelial corneal dystrophy). […] As Fuchs’ dystrophy usually progresses slowly, many people won’t develop symptoms for years after diagnosis. […] Fuchs’ dystrophy is a corneal dystrophy that typically progresses slowly over decades. You’ll need regular eye exams so your optometrist can monitor your disease progression. […] At a later stage, blisters can develop on the outer layer of cells on the surface of the cornea (the epithelium). […] Life won’t change very much after the diagnosis of Fuchs’ dystrophy. You’ll have regular eye exams to monitor the condition and, if mild symptoms develop, taking eye drops may become part of your daily routine. […] If you develop severe symptoms, a corneal transplant is usually an option to improve your vision. However, if you have lasting symptoms, or a transplant is not successful, and you have significant vision loss, you may be considered to have a disability. […] Fuchs’ dystrophy generally progresses slowly, so although you may be diagnosed in your 30s or 40s, it can take 10 to 20 years for symptoms to develop and progress.

• #65 Fuchs’ Dystrophy | Your Eye Health

  https://www.guidedogs.org.uk/getting-support/information-and-advice/eye-conditions/fuchs-dystrophy/

  Fuchs’ dystrophy can be diagnosed by closely examining the back layer of the cornea. Your optician may do the following tests to diagnose Fuchs’ dystrophy: […] Use a slit lamp to examine your eye and look for irregular bumps (guttae) at the back of the cornea. […] Measure the corneal thickness with a corneal pachymetry test. […] Take a photograph of the cornea (called tomography). […] An optician can refer you to an ophthalmologist if you need help with symptoms.

• #66 Living with Fuchs’ Dystrophy | Help & Support

  https://www.guidedogs.org.uk/getting-support/information-and-advice/eye-conditions/fuchs-dystrophy/living-with-fuchs-dystrophy/

  Adults in their 50s and 60s, particularly women, are more likely to be living with Fuchs’ dystrophy (also called Fuchs’ endothelial corneal dystrophy). […] As Fuchs’ dystrophy usually progresses slowly, many people won’t develop symptoms for years after diagnosis. […] Fuchs’ dystrophy is a corneal dystrophy that typically progresses slowly over decades. You’ll need regular eye exams so your optometrist can monitor your disease progression. […] At a later stage, blisters can develop on the outer layer of cells on the surface of the cornea (the epithelium). […] Life won’t change very much after the diagnosis of Fuchs’ dystrophy. You’ll have regular eye exams to monitor the condition and, if mild symptoms develop, taking eye drops may become part of your daily routine. […] If you develop severe symptoms, a corneal transplant is usually an option to improve your vision. However, if you have lasting symptoms, or a transplant is not successful, and you have significant vision loss, you may be considered to have a disability. […] Fuchs’ dystrophy generally progresses slowly, so although you may be diagnosed in your 30s or 40s, it can take 10 to 20 years for symptoms to develop and progress.

• #67 What You Should Know About Fuch’s Dystrophy – New Jersey Eye Center

  https://thenjeye.com/know-fuchs-dystrophy/

  Specular microscopic exams are highly effective at making accurate diagnoses of the cornea. The exam measures the density of the endothelium cells and their growth patterns within the layers of the cornea. […] Dystrophy of the eye may be present if you have a hard time making out these figures or report seeing clouds, or glare. […] While there is no cure for Fuchs dystrophy, the ophthalmologic community has identified some ways in which it can be managed. […] If you believe that you’re experiencing symptoms of Fuchs dystrophy, then you may want to consider seeing your eye doctor before symptoms progress. […] To ensure that you stay aware of the presence of Fuchs dystrophy, stay up to date with your annual eye examinations.

• #68 Fuchs’ Dystrophy | Symptoms, Causes,Treatment | Wills Eye Hospital

  https://www.willseye.org/fuchs-dystrophy/

  The diagnosis can usually be made during a slit lamp examination. Ancillary testing can include measurement of the corneal thickness (pachymetry) and endothelial cell imaging (specular microscopy). […] Treatment ranges from observation in mild cases to salt drops and ointment (hypertonic sodium chloride 5%) to surgery including partial thickness corneal transplant (e.g. Descemets stripping endothelial keratoplasty [DSEK] or Descemets membrane endothelial keratoplasty [DMEK]) or a full thickness corneal transplant (especially in eyes with corneal scarring). In some patients with fairly mild and central Fuchs dystrophy, removal of the abnormal cells without a corneal transplant (Descemets stripping only [DSO]) may be an option.

• #69

  https://www.aao.org/eye-health/diseases/what-is-fuchs-dystrophy

  Fuchs’ Diagnosis Your ophthalmologist will look closely at your cornea and measure its thickness. This is called pachymetry. They will also check for tiny blisters on the front surface of the cornea and drop-like bumps of the back surface of the cornea (guttae). Using a special photograph of your cornea, your ophthalmologist may count your endothelial cells. […] There is no cure for Fuchs dystrophy. However, you can control vision problems from corneal swelling. Your treatment depends on how Fuchs dystrophy affects your eyes cells.

• #70 A Review of the Management of Fuchs Endothelial Corneal Dystrophy – The Journal of Medical Optometry (JoMO)

  https://journalofmedicaloptometry.com/volume2-issue1/a-review-of-the-management-of-fuchs-endothelial-corneal-dystrophy/

  Various software programs are available to analyze the images and provide clinically useful indices: the cell density (CD) is measured in cells/mm,2 pleomorphism is measured by the hexagonal percentage (HEX), and polymegethism is measured by the coefficient of variation (CV). […] In advanced FECD, when the endothelial view is compromised by edema, in vivo confocal microscopy may be utilized. […] As FECD progresses, corneal thickness, polymegethism, and pleomorphism all increase. […] No current medical treatment can arrest the progression of FECD. […] Surgical decisions are based on signs and symptoms. […] Reduced visual acuity and the presence of corneal edema indicate corneal endothelial decompensation warrant surgical intervention. […] Traditionally, the only surgical option to treat FECD was PKP.

• #71 A Review of the Management of Fuchs Endothelial Corneal Dystrophy – The Journal of Medical Optometry (JoMO)

  https://journalofmedicaloptometry.com/volume2-issue1/a-review-of-the-management-of-fuchs-endothelial-corneal-dystrophy/

  As a result of innovations in endothelial keratoplasty (EK) over the last 20 years, EK has replaced PKP as the preferred treatment. […] Hence, surgical intervention is now recommended earlier in the disease course. […] The two methods of EK utilized are DSEK and DMEK. […] Future therapies of endothelial replacement are underway. […] Rho-associated kinase (ROCK) inhibitors represent a new pharmaceutical therapy for FCED. […] Studies involving ROCK inhibitors in FECD have demonstrated the ability to reduce corneal edema and improve vision by promoting endothelial cell proliferation and adhesion while reducing endothelial cell apoptosis. […] The use of ROCK inhibitors for endothelial dysfunction is currently off label in the United States. […] When considering cataract surgery in a patient with FECD, it is important to discuss with the patient the increased risk of pseudophakic bullous keratopathy. […] Significant therapeutic and surgical advancements have been introduced which can help to offer earlier intervention, improve quality of life, and improve visual outcomes.

• #72 Fuchs Dystrophy and Cataract: Diagnosis, Evaluation and Treatment – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36637659/

  Corneal endothelium plays an important role in maintaining hydration homeostasis and clarity of the cornea. Fuchs endothelial corneal dystrophy (FECD) affects the corneal endothelium resulting in edema and characteristic excrescences on the Descemet’s membrane known as corneal guttae. Descemet membrane endothelial keratoplasty (DMEK) has evolved to become the standard of care for patients with FECD with excellent visual acuity outcomes. Patients with FECD may have coexisting cataracts and therefore may require a cataract surgery, which increases the risk of corneal decompensation. The presence of FECD may not only influence the choice of intraocular lens but vision outcomes can also be affected by the corneal condition. The ability to combine the surgeries further raises important considerations regarding the timing and sequence of DMEK and cataract extraction for patients with FECD. […] This review provides a guide for corneal surgeons in choosing between endothelial keratoplasty and cataract surgery-alone, in combination or sequential-in their management of patients with FECD.

• #73

  https://link.springer.com/article/10.1007/s40123-022-00637-1

  Corneal endothelium plays an important role in maintaining hydration homeostasis and clarity of the cornea. Fuchs endothelial corneal dystrophy (FECD) affects the corneal endothelium resulting in edema and characteristic excrescences on the Descemets membrane known as corneal guttae. The diagnosis of FECD is made primarily based on clinical findings and history. The progression of the disease is bilateral but may be asymmetric with four clinical stages over 2 to 3 decades. The first stage is characterized by the hallmark finding of non-confluent corneal guttae, which can be noted on slit-lamp examination. While it has been thought that patients generally have no complaints in the early stages, recent studies suggest that patients may have a lot of glare and color vision defects even in mild stages. The ability to combine the surgeries further raises important considerations regarding the timing and sequence of DMEK and cataract extraction for patients with FECD. Corneal surgeons factor in clinical history, examination, diagnostic tests (e.g., corneal tomography, specular and pachymetry), practice patterns and patient preference to make the decision of offering endothelial keratoplasty and cataract surgery alone, in combination or sequential. Diagnostic testing can be particularly helpful in evaluating patients without clinically evident edema by detecting subclinical edema and identifying eyes that would be higher risk for corneal decompensation. Typically, an endothelial cell density (ECD) of 500/mm2 is required to maintain corneal clarity, and eyes with EC counts 1000 are more likely to decompensate. However, the cell counts can be difficult to accurately measure in eyes with FECD, and cell counts do not adequately assess function. In a series of studies, Patel and colleagues have delineated tomographic findings on scheimpflug imaging that can be used to detect subclinical edema. Thus, the use of tomography can help predict which eyes may not benefit from cataract surgery alone or have a higher risk of needing EK in the future. For patients with both a visually significant cataract and FECD, either a DMEK triple procedure or a staged procedure can be considered. The DMEK triple procedure provides rapid visual recovery and limits the risks and costs associated with two separate procedures. A study looking at 203 eyes reported that the rates of graft dislocation after triple DMEK remain low with no graft failure at 6 months. Thus, the decision to perform a staged versus combined procedure should be based on surgeon experience.

• #74

  https://link.springer.com/article/10.1007/s40123-022-00637-1

  Corneal endothelium plays an important role in maintaining hydration homeostasis and clarity of the cornea. Fuchs endothelial corneal dystrophy (FECD) affects the corneal endothelium resulting in edema and characteristic excrescences on the Descemets membrane known as corneal guttae. The diagnosis of FECD is made primarily based on clinical findings and history. The progression of the disease is bilateral but may be asymmetric with four clinical stages over 2 to 3 decades. The first stage is characterized by the hallmark finding of non-confluent corneal guttae, which can be noted on slit-lamp examination. While it has been thought that patients generally have no complaints in the early stages, recent studies suggest that patients may have a lot of glare and color vision defects even in mild stages. The ability to combine the surgeries further raises important considerations regarding the timing and sequence of DMEK and cataract extraction for patients with FECD. Corneal surgeons factor in clinical history, examination, diagnostic tests (e.g., corneal tomography, specular and pachymetry), practice patterns and patient preference to make the decision of offering endothelial keratoplasty and cataract surgery alone, in combination or sequential. Diagnostic testing can be particularly helpful in evaluating patients without clinically evident edema by detecting subclinical edema and identifying eyes that would be higher risk for corneal decompensation. Typically, an endothelial cell density (ECD) of 500/mm2 is required to maintain corneal clarity, and eyes with EC counts 1000 are more likely to decompensate. However, the cell counts can be difficult to accurately measure in eyes with FECD, and cell counts do not adequately assess function. In a series of studies, Patel and colleagues have delineated tomographic findings on scheimpflug imaging that can be used to detect subclinical edema. Thus, the use of tomography can help predict which eyes may not benefit from cataract surgery alone or have a higher risk of needing EK in the future. For patients with both a visually significant cataract and FECD, either a DMEK triple procedure or a staged procedure can be considered. The DMEK triple procedure provides rapid visual recovery and limits the risks and costs associated with two separate procedures. A study looking at 203 eyes reported that the rates of graft dislocation after triple DMEK remain low with no graft failure at 6 months. Thus, the decision to perform a staged versus combined procedure should be based on surgeon experience.

• #75 Fuchs’ dystrophy – Wikipedia

  https://en.wikipedia.org/wiki/Fuchs%27_dystrophy

  Fuchs dystrophy is classified into 4 stages, from early signs of guttae formation to end-stage subepithelial scarring. Diagnosis is made by biomicroscopic examination in the clinic. Other modalities, such as corneal thickness measurement (pachymetry), in-vivo confocal biomicroscopy, and specular microscopy can be used in conjunction. […] The diagnosis of Fuchs dystrophy is often made with slit lamp biomicroscopy. With direct illumination, the clinician can visualize guttae, the characteristic pathological changes in disease. […] Scheimpflug imaging, anterior segment optical coherence tomography, confocal microscopy, and specular microscopy are additional imaging techniques that can identify the presence of guttae and quantify the thickness of the cornea. While corneal thickness can be a valuable indicator of how the cornea is changing over time, it is affected by multiple factors and is not adequate itself as a screening tool to diagnose Fuchs dystrophy.

• #76 Fuchs’ Dystrophy – Clinical Services – Robert Cizik Eye Doctors Clinic

  https://www.cizikeyedoctors.org/clinical-services/fuchs-dystrophy

  Besides testing your vision, your doctor will examine and grade your cornea with a slit lamp. The thickness of your cornea may be measured, and special pictures may be taken to look for signs of swelling in the cornea. Your doctor may also examine the size, shape and count of the cells that line the back of the cornea. With those details, your doctor can determine the stage of the disease and develop the best treatment plan.

• #77 Fuchs’ Dystrophy: Causes, Symptoms, Diagnosis, and Treatment

  https://resources.healthgrades.com/right-care/eye-health/fuchs-dystrophy

  Fuchs’ dystrophy is an eye condition wherein the endothelial cells in the cornea malfunction. These cells are responsible for keeping the cornea clear by removing fluid. As such, this condition causes fluid buildup and swelling. […] Read on to learn more about the causes, symptoms, diagnostic process, and treatments for Fuchs’ dystrophy. […] In addition to assessing your medical history, there are a few methods doctors can use to diagnose Fuchs’ dystrophy: Slit-lamp examination: This examination allows doctors to determine the presence of guttae. In the later stages, blisters and scarring may also be visible. Specular microscopy: Doctors use this test to assess if the endothelial cells are dying off. Pachymetry: Pachymetry helps determine the thickness of the central cornea. Increased thickness can indicate fluid buildup.

• #78 Reddit – The heart of the internet

  https://www.reddit.com/r/CataractSurgery/comments/1hcros0/important_have_your_eyes_checked_for_fuchs/

  „I think you have Fuch’s dystrophy. This is a progressive disease that you have probably had for years but weren’t aware of it.” […] „It’s best to diagnose Fuch’s prior to cataract surgery because it can affect which lenses are best for you and the surgical technique is modified to reduce cornea damage.” […] „Although progression can’t be stopped, it can be slowed. You want to catch Fuch’s early to slow down the damage with medication.” […] „With Fuch’s disease, the absolute WORST IOL to select is one that reduces light level and contrast (typically, multifocals).” […] „With Fuch’s, every surgery to the cornea makes the condition worse.” […] „The key is to catch it BEFORE this point so that progression can be slowed and appropriate decisions made around IOL selection in the future.” […] „I am highly suggesting that you request your optometrist, opthalmologist and cataract surgeon to check for Fuch’s dystrophy prior to your cataract surgery.”

• #79 Fuchs Dystrophy – Northeast Wisconsin Vision Center

  https://newvisioncenter.com/eye-conditions/fuchs-dystrophy/

  Fuchs dystrophy is a common disease of the cornea. […] Often people become aware of the condition when discussing cataract surgery with their eye surgeon. The reason is that cataract surgery can make the Fuchs dystrophy worse. […] The treatments for Fuchs dystrophy include using a salt-solution eye drops or a cornea transplant. […] For more significant cases, the only solution is a cornea transplant. […] Dr. Larson and Dr. Raven are cornea specialists and take care of many patients with Fuchs dystrophy. They regularly perform cornea transplants and are available for a consultation at N.E.W. Vision Center.

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