Descemete Stripping Only For Fuchs Endothelial Corneal Dystrophy

Our aim is to present preoperative criteria and postoperative outcomes in a case series of patients with Fuchs endothelial corneal dystrophy, who underwent Descemet stripping only. There is increasing proof in recent literature that some patients with central Fuchs phenotype benefit from removal of affected tissue only, after which migration of surrounding endothelial cells occurs and results in central corneal clearing. 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.

University Eye Hospital University Clinical Centre Ljubljana.

Descemet stripping was performed in 6 eyes of 6 patients with Fuchs endothelial corneal dystrophy from 2019 to 2022. Patients selected had decreased best corrected visual acuity (BCVA), blurred distance vision, increased central corneal thickness (CCT), less than 4 mm of the central corneal endothelium affected and preserved peripheral endothelial count (ECC) (1800 cells/mm² or more). Cataract surgery was performed before or at the day of Descemet stripping. Preoperative and postoperative examination included BCVA (Snellen), CCT (Heidelberg Spectralis OCT), endothelial cell count (Tomey Specular Microscope). The central 4 to 5 mm of Descemet membrane were peeled off. Postoperative therapy included topical corticosteroids and antibiotics.

Six patients have undergone Descemet stripping only, average age at the time of surgery was 60,5 years [51-72]. The average follow-up was 8 [2-18] months. Preoperative BCVA increased from an average of 0,5 to 0,67 (0,3 to 1.0) postoperatively. Complete clearance of corneal oedema was observed in two patients, however an improvement or stability of visual acuity was observed in all patients. No patients needed subsequent endothelial keratoplasty.

There is increasing proof in recent literature 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.