More About The Cornea
Occurring in up to 5% of the population over 40, Fuch’s Dystrophy is a common eye condition that affects the cornea.
Certain people may be predisposed to Fuch’s Dystrophy, but eye trauma can play a role in the disease. Some studies suggest that oxidative damage is a factor, and that antioxidants might help prevent the condition.
Progression of this condition is often slow. Over years, Fuch’s Dystrophy can progress to severe visual impairment and corneal transplant can become necessary.
Causes of Fuch’s Dystrophy
The cornea is a the transparent covering on the front of the eye that works with the lens to help focus light. Because of its role in focusing, the cornea’s shape determines whether a person is nearsighted or farsighted.
The cornea of the eye is lined with cells called endothelial cells. In Fuch’s Dystrophy, these cells deteriorate. As they break down, the surface of the cornea cannot remove water as well. Because of this, water collects and the lens becomes swollen to the point that it distorts vision. At the same time, collagen collects in areas of the cornea which causes abnormal areas called guttate lesions.
Fuch’s Corneal Dystrophy Symptoms
People can have signs of Fuch’s Dystrophy on eye exam as early as their 30s, but visual changes may not occur for another twenty or thirty years. The main symptom is blurry vision, which is worse in the morning and improves as the day goes on.
Over time, as the disease progresses, vision may be permanently blurry or progress to complete blindness. People with Fuch’s Dystrophy may have other symptoms including seeing halos of light and light sensitivity. A person with Fuch’s Dystrophy can also have a visibly cloudy cornea.
Treatment of Fuch’s Dystrophy
Treatment consists of reducing the swelling with eye drops, ointments, or soft contact lenses. If the symptoms progress, a corneal transplant may be necessary. Fortunately, this surgery has a high success rate.
Dr. Schaible at Community Eye Center performs corneal transplants at St. Lucy’s Eye Surgery Center in Port Charlotte.
Keratoconus is a condition where the cornea develops progressive thinning. This can be treated in a number of ways. One of the treatments, which is approved in this country, is the use of intacts rings to stabilize the cornea from progression early in the disease process. The intacts rings can then be removed later in life when the patient may require a PKP. Penetrating Keratoplasty is the mainstay of therapy in this country with progressive thinning of the cornea. This is a through and through dissection of the tissue. The following procedure not available in this country at this time is cross-linking, which when available, will help the progression of Keratoconus in the early stages.
The cornea represents the clear window in front of the eyeball. This is the most important refractive surface we have in the refractive anatomy of the eye. It accounts for 2/3 of the eyes refractive power, the air/tear film interface. If the cornea is irregular, the image will be blurry. If the cornea has astigmatism, the person will see a distorted image. The cornea is approximately the size of a dime, 550 microns in thickness or about 10-11 millimeters. Frequently, the cornea can be associated with reduction and transmission of light because of an inheritable disease called Fuch’s corneal dystrophy. Fuch’s corneal dystrophy is seen more frequently in women by a factor of 3:1 and results in thickening of the cornea and the loss of transmission of light. Various procedures are available for this condition; such as PKP (Penetrating Keratoplasty) a through and through-thickness corneal transplant, DSAEK procedure (Descemet’s Stripping Automated Endothelial Keratoplasty) to remove the posterior endothelial cells which are deficient in number with the replacement of graft tissue and DMEK or Descemet’s Membrane Endothelial Keratoplasty. These procedures are the mainstay of modern corneal transplants for endothelial dystrophies.
Regarding corneal scarring, PKP is the mainstay of therapy. This is the most common procedure performed for local burns to the cornea.
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