DESCEMETE STRIPPING ONLY FOR FUCHS ENDOTHELIAL CORNEAL DYSTROPHY

Our aim is to present preoperative criteria and postoperative outcomes in a case series of patients with Fuchs endothelial corneal dystrophy who underwent Descemet stripping only.

University Eye Hospital University Clinical Centre Ljubljana.

Descemet stripping was performed in 8 eyes of 7 patients with Fuchs endothelial corneal dystrophy from 2019 to 2022. Patients selected had decreased best corrected visual acuity (BCVA), blurred distance vision, increased central corneal thickness (CCT), less than 4 mm of the central corneal endothelium affected and preserved peripheral endothelial count (ECC) (1800 cells/mm² or more). Cataract surgery was performed before or at the day of Descemet stripping. Preoperative and postoperative examination included BCVA (Snellen), CCT (Heidelberg Spectralis OCT), endothelial cell count (Tomey Specular Microscope). The central 4 to 5 mm of Descemet membrane were peeled off. Postoperative therapy included topical corticosteroids and antibiotics.

Seven patients have undergone Descemet stripping only, average age at the time of surgery was 62,5 years [51-74. The average follow-up follow-up 8,3 [2-17] months. Patients with preoperative CCT <800 microns were included in our study (all had a preoperative CCT of <700 microns)and two patients with extensive preoperative corneal oedema (CCT>800microns) were excluded from the analysis. Preoperative BCVA increased from an average 0,61 Snellen preoperatively to 0,8 Snellen [0,3-1.0] postoperatively and CCT decreased by 42 µm.  In all 6 eyes, postop central CEC were seen on specular biomicroscopy. No patients needed subsequent endothelial keratoplasty.

In our case series the early stage of central Fuchs dystrophy, pseudophakia and good patient cooperation were connected to a favourable visual outcome. Descemet stripping only is a minimally invasive and cost-effective surgery with few intraoperative and postoperative complications. Careful patient selection for the procedure and patient counselling is crucial.