Descemete Stripping Only For Fuchs Endothelial Corneal Dystrophy – Review Of Results From A Tertiary Centre In Slovenia

We present a case series of patients with Fuchs' endothelial dystrophy and central corneal decompensation with preserved peripheral endothelial cell count that have undergone central Descemet stripping only.

Patients were operated on and followed up by consultant surgeons and followed up in a tertiary centre – University Clinical Centre Ljubljana.

Descemet stripping was performed in 17 eyes of 15 patients with Fuchs endothelial corneal dystrophy in the years 2019-2023. Patients selected had decreased best corrected visual acuity (BCVA), blurred distance vision, increased central corneal thickness (CCT), less than 4.5 mm of the central corneal endothelium affected and preserved peripheral endothelial count (ECC) (1800 cells/mm² or more).  Preoperative and postoperative examination included BCVA (Snellen), CCT (Heidelberg Spectralis OCT), (Tomey Specular Microscope). The procedure was peeling central 4-4,5 mm of Descemet membrane with adjacent affected endothelium.

15 patients have undergone Descemet stripping only, average age was 69,6 years at the time of the procedure [57-83] and the average follow-up period was 15,6 [1,07-41,5] months. BCVA increased from an average of 0,55 preoperatively to 0,79 postoperatively, and 10 out of 17 eyes had BCVA 0.9 or better. Mean central corneal thickness decrease on average was 58 µm. Complete clearance of corneal oedema was observed in 15 out of 17 eyes, two patients only proceeded to have Descemet membrane endothelial keratoplasty. In the 15 eyes with clearance of corneal oedema, we detected a measurable endothelial cell count in 11 patients, the average ECC was 1070/mm2 [620-1452].

There is increasing proof that some patients with central Fuchs' phenotype benefit from removal of affected tissue only. The optimal patient selection for Descemet stripping only is still under research. 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