Fuchs endothelial corneal dystrophy: current treatment recommendations and experimental surgical options

Fuchs endothelial corneal dystrophy is a common disorder characterized by the progressive thickening of Descemet membrane (DM), manifesting as guttae and leading to a decrease in endothelial cells and corneal clearance. Numerous studies have tried to better characterize the genetics of Fuchs endothelial corneal dystrophy, and suggest that it is a complex heterogenic disorder with an array of variants in severity and disease progression. Currently the most effective treatment for replacing diseased endothelium is endothelial keratoplasty (EK). In the last decade, EK has evolved into selective transplantation of an isolated DM and its endothelium, referred to as Descemet membrane endothelial keratoplasty (DMEK), which enables near normal anatomical and visual outcomes after surgery. Unexpected observations after DMEK, however, may bring new insights on endothelial cell wound healing, potentially allowing novel ‘non-keratoplasty’ surgical approaches like Descemet membrane endothelial transfer, endothelial cell injection techniques or even only a descemetorhexis as alternatives for selected cases.