Treating Fuchs' Endothelial Dystrophy With Descemetorhexis Without Endothelial Keratoplasty And Rho-Associated Kinase Inhibitors Eye-Drops

Fuchs endothelial corneal dystrophy (FECD) is a progressing dystrophy involving the corneal endothelial layer. As the disease worsens, the cornea develops guttae and thickening of Descemet's membrane, causing corneal edema, and reduced visual acuity. Corneal transplantation is the first-choice treatment for late stages of FECD. In this case report, we will report a female patient that underwent Descemet stripping without endothelial Keratoplasty (DWEK), which is an innovative surgery type and has just become popular these years. After the surgery, we applied Rho kinase inhibitor eye-drops qid to observe the disease outcome, which is promising. 

The Chinese PLA General Hospital, Beijing, China.

A 50-year-old female developed symptoms of eye dryness, pain, and blurry vision without apparent cause in her left eye four years ago, and the symptoms worsened over the past three months. Her best corrected vision acuity (BCVA) was 20/40.  Slit lamp examination revealed significant corneal stromal edema and thickening, as well as guttae in the center of the cornea, while the peripheral endothelial cells appeared hexagonal and tightly connected. Confocal microscopy showed that the total corneal endothelium count is 1844 cells/mm2 in the patient's left eye. She was diagnosed Fuchs endothelial corneal dystrophy.

We performed Descemetorhexis Without Endothelial Keratoplasty (DWEK) on the left eye and carefully stripped away a 4mm circle of central diseased endothelial cells, not scraping Descemet's membrane, avoid engaging corneal stroma and without placing any donor cornea tissue. We prescribed a Rho kinase inhibitor eye-drop (ripasudil) qid after the surgery.

On the second day after surgery, the surgical area was cloudy and swollen and the BCVA temporarily worsened in the first month, which was 20/320. After 2 months, the patient achieved lasting corneal clarity and the BCVA reached 20/32. Followed up for 1 year, the patient doesn’t need endothelial keratoplasty so far and the BCVA maintained at 20/32.

DWEK requires no donor cornea, with fewer risks and complications such as immune rejection, and saves FECD patients from endothelial transplantation, which provides an additional choice. The use of a topical Rho kinase inhibitor may improve corneal endothelial proliferation and corneal clearance. The combination of these two treatment modalities may offer even greater benefits to patients with FECD, and further research is needed to fully evaluate their efficacy and safety. According to case reports, the success rate of DWEK can be as high as 83% when appropriate patients are selected. At present, there are only a relatively small number of DWEK cases in China.