Topical Ascorbic Acid for Corneal Endothelial Cell Density Enhancement, Protection, and Recovery in Fuchs Dystrophy After Complicated Cataract Surgery

We report a case highlighting the potential of topical ascorbic acid (AA) as an adjunctive strategy for supporting corneal endothelial stability in Fuchs endothelial corneal dystrophy (FECD) after complicated cataract surgery. A 74-year-old man with bilateral FECD presented with progressive vision loss. Baseline endothelial cell density (ECD) was 1,996 cells/mm2 in the right eye and 1,988 cells/mm2 in the left eye. After 15 months of AA treatment, ECD increased to 3,079 and 3,008 cells/mm2, respectively. The left eye underwent uncomplicated cataract surgery with minimal ECD loss (9.61%). The right eye suffered posterior capsule rupture requiring vitrectomy, causing a 67.08% ECD loss (to 1,036 cells/mm2) and corneal edema. With continued AA treatment for 64 months, the ECD in the right eye improved to 2,080 cells/mm2. Corneal clarity and stability were also clinically improved. This case suggests that topical AA may improve endothelial stability in FECD eyes, even after complicated surgeries. The intrapatient comparison provides observational support for a potential association between topical AA use and endothelial stability.