Descemet Stripping Only (Dso): A Pragmatic Approach For Managing Fuchs’ Endothelial Corneal Dystrophy (Fecd)

Descemet Stripping Only (DSO) is a graft-free option for selected patients with Fuchs’ endothelial corneal dystrophy (FECD). In this first UK report of DSO outcomes, we assessed results using routinely available clinical markers of endothelial function, without reliance on pre- or post-operative endothelial cell counts or imaging, which are less widely available and may be unreliable.

University Hospital of Wales (tertiary centre), Cardiff, Wales, UK

This retrospective service evaluation included 17 eyes of 14 patients who underwent combined phacoemulsification, intraocular lens implantation, and 4-mm central DSO between January 2024 and September 2025. All eyes had central confluent guttae with clinically healthy peripheral endothelium. Outcomes included best-corrected visual acuity (BCVA), central corneal thickness (CCT), time to corneal clarity, refractive change, corneal tomography, complications, and need for rescue endothelial keratoplasty. Specular microscopy was performed postoperatively when feasible but was not required for outcome assessment. Paired statistical analyses were used, with p<0.05 considered significant.

Fifteen of 17 eyes (88%) achieved corneal clarity within 3 months. Mean BCVA improved from 0.53 ± 0.29 LogMAR preoperatively to 0.06 ± 0.17 LogMAR at final follow-up (mean 13.1 months; p=0.00044). Mean CCT decreased from 613.2 ± 87.7 µm to 515.3 ± 30.0 µm (p=0.0007). Two eyes (12%) required rescue endothelial keratoplasty. Tomographic parameters remained stable. Endothelial cell counts were measurable in 40% of successful cases (mean 1054 ± 258 cells/mm²).

DSO achieves corneal clearance with significant visual and pachymetric improvement using accessible clinical markers, enabling reliable assessment without routine specular microscopy in resource-variable settings.