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Fuchs endothelial dystrophy: new hopes for endothelial regeneration

Posted: May 22 2013
diagram of fuchs dystrophy endothelial cells

Fuchs endothelial dystrophy is a relatively common condition which leads to gradual loss of function of the corneal endothelial cells and increasing corneal swelling, haziness, and loss of vision. In my own practice my preferred method for treating cases of Fuchs dystrophy is to perform a corneal endothelial transplant (DSAEK) which replaces the sick endothelial cells with a large number of healthy cells from a donor. I use the Tan Endoglide for DSAEK, a device that has been shown to cause the least amount of damage to the transplanted cells during surgery, thus leaving the patient with the maximal deliverable number of cells.

The human corneal endothelium is a single layer of cells that lines the inner surface of the cornea. These specialised cells act like pumps that draw water out of the cornea, keeping it clear and transparent. In Fuchs dystrophy and other conditions affecting the endothelial cells, these pumps fail and the cornea becomes water logged and swells.This causes the collagen fibres within the cornea to become displaced and scatter light, causing haziness and dullness of the cornea. Endothelial cells do not appear to divide during our life time, and the number that we are born with gradually declines as we age. The remaining cells simply expand in size to take up this redundant space. In Fuchs dystrophy this process is accelerated and patients in their 50s and above can begin to lose vision.

DSAEK and other surgeries are aimed at replacing damaged endothelial cells. Much recent attention has focused on regeneration of existing endothelial cells to try and induce them to divide and increase in number. Some progress has been made, and may one day mean that patients with Fuchs dystrophy could be treated with a drop that regenerates their endothelium rather than by surgery.

Images in this post are taken from Zavala J, López Jaime GR, Rodríguez Barrientos CA, Valdez-Garcia J. Corneal endothelium: developmental strategies for regeneration. Eye (Lond). 2013 May;27(5):579-88

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