How common are cornea transplants in the treat-ment of this disease? Cornea transplants are uncom-mon but are common in the treatment of Fuchs’ Corneal Dystrophy. Cornea transplants are a very routine proce-dure. Success rates for cornea transplants being successful has risen over the last two decades.

What is involved in performing corneal trans-plant surgery?

Eye drops will be put in the eyes. An oral sedative will be given . The patient will be taken to the operating room and given a local anesthesia.

Once the corneal transplant is completed, a patch and protective metal shield will be placed over the operated eye. Patients are sent to the recovery room where they will be observed before being discharged home with fami-ly and friends.

What are the risks involved with cornea trans-plant surgery?

As with most surgeries, there are always risks involved with any surgical procedure. These problems can usually be divided into two categories. These are those that occur at the time of the surgery itself and those that take place after this surgery. Problems which can occur afterward include glaucoma, infection, retinal swelling or detach-ment, and cataracts. Rarely, there can be loss of all sight. These risks are similar to those associated with other types of ocular surgery such as glaucoma and cataract surgery. One complication that is unique to corneal transplantation is donor tissue rejection by the patient’s body

FUCHS’ CORNEA

DYSTROPHY

WHAT IT IS?

WHAT ARE THE SYMPTHOMS?

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Organizer of First United States Lasik Course

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First textbook chapter written on the lasik technique

First textbook chapter written on hyperopic lasik

First textbook chapter on Suture-less Corneal Transplantation

Editor Advances in Refractive & Corneal Surgery

Over 10,000 cataract and 30,000 lasik surgeries performed

How is Fuch’s Cornea Dystrophy detected?

Fuchs’ is detected by examining the cornea with a slit lamp microscope that magnifies the endothelial cells thousands of times. The health of the endothelium is evaluated and monitored with pachymetry and specular microscopy

How long do I have between diagnosis of Fuchs’ Corneal Dystrophy and actually having to get an actual cornea transplant?

That is actually hard to say as everyone responds differently to the progression of the disease. Fuchs’ gen-erally tends to move very slowly when it comes to the progression of the disease. Most of those who discover they have the disease find out in their 30s and 40s. Most people do not do anything until its necessary. Symptoms generally tend to more prevalent when patients are in their 50s and 60s. It has been known to show up earlier than that well. This really depends on the person and their response to the progression of the disease.

Injury to the cornea can occur because of burns from chemicals, mechanical trauma, or infection by vi-ruses, bacteria, fungi, or protozoa. Herpes virus is one of the more common infections leading to corneal trans-plant.

Surgery would only be used when damage to the cornea is too severe to be treated with corrective lenses. Occasionally, corneal transplant is combined with other types of eye surgery and is used frequently with cataract surgery solve multiple eye problems in one procedure.

Symptoms of the Fuchs' Corneal Dystrophy: You may have the gene for Fuchs’ Corneal Dystrophy if you have one or more of the following symptoms:

Hazy vision that is often most pronounced in the morning

Fluctuating vision that is often most pronounced in the morn-ing

Glare when looking at lights

Light sensitivity

Sandy, gritty sensation What can I do to stop having these problems with my eyes? Most people who are diagnosed with this disorder are told so in their 30s-40s when the signs first begin to appear. Since each case of Fuchs is unique and different, its hard to say what will hap-pen with you. Fuchs’ cannot be cured; however, with certain medications, blurred vision resulting from the corneal swelling can be controlled. Salt based solutions such as sodium chloride drops or ointment are often prescribed. These solutions will draw fluid from the cornea and reduce swelling. Another way to reduce cornea moisture is to hold a hair dryer at arm’s length. One should blow air into the face with the eyes closed. This technique removes moisture from the cornea. It will temporarily decrease swelling, and improves the vision.

In the early stages of this disease, patients will notice glare and light sensitivity. As it progresses, the vision may seem blurred in the morning and sharper later in the day. This occurs due to the internal layers of the cornea tend to retain more moisture during sleep. This same moisture evaporates while the eyes are open. As the dystrophy worsens, the vision becomes continuously blurred.

WHAT IS THE CORNEA?

The cornea is the eye's outermost layer. It is the clear, dome-shaped surface that covers the front of the eye.

Structure of the Cornea Although the cornea is clear and seems to lack substance, it is actually a highly organized group of cells and proteins. Unlike most tissues in the body, the cornea contains no blood vessels to nourish or protect it against infection. The cornea must remain transparent to refract light properly, and the presence of even the tiniest blood vessels can interfere with this process. To see well, all layers of the cornea must be free of any cloudy or opaque areas. The corneal tissue is arranged in five basic layers, each having an important function. These five layers are:

Epithelium: The epithelium is the cornea's outermost region, comprising about 10 percent of the tissue's thick-

ness. In advanced Fuch’s blisters will form on the corne-al endothelium. They are an indication of corneal failure and can initially be treated. Rupture of the blisters is painful.

Bowman's Layer Lying directly below the basement membrane of the epi-thelium is a transparent sheet of tissue known as Bow-man's layer. It is composed of strong layered protein fibers called collagen. Stroma Beneath Bowman's layer is the stroma, which comprises about 90 percent of the cornea's thickness. It consists pri-marily of water (78 percent) and collagen (16 percent), and does not contain any blood vessels. Collagen gives the cornea its strength, elasticity, and form. The collagen's unique shape, arrangement, and spacing are essential in producing the cornea's light-conducting transparency. Descemet's Membrane Under the stroma is Descemet's membrane, a thin but strong sheet of tissue that serves as a protective barrier against infection and injuries. Endothelium The endothelium is the extremely thin, innermost layer of the cornea. Endothelial cells are essential in keeping the cornea clear. Normally, fluid leaks slowly from inside the eye into the middle corneal layer (stroma). The endotheli-um's primary task is to pump this excess fluid out of the stroma. Without this pumping action, the stroma would swell with water, become hazy, and ultimately opaque. In a healthy eye, a perfect balance is maintained between the fluid moving into the cornea and fluid being pumped out

Once endothelium cells are destroyed by disease or trauma, they are lost forever. If too many endothelial cells are destroyed, corneal edema and blindness ensue, with corneal transplantation the only available therapy.

Fuchs' Corneal Dystrophy is an inherited condition. It affects the inner layer of the cornea called the endothelium. The endo-thelium functions as a pump mechanism. It pumps or removes fluid from the cornea. This allows the cornea to maintain its clarity. Those who have been diagnosed with Fuchs’ Corneal Dystrophy lose the function of these endothelial cells.

Once these cells lose their functional purpose, they will not regenerate themselves. The pump functions of these cells will be less efficient or effective. This will cause the cornea to become cloudy. It will also cause swelling and eventually re-duced vision. This disease is much more common in women than men by almost a 3-1 margin.

Epithelial swelling causes tiny blisters on the corneal sur-face. It also damages vision. When these blisters burst, they are extremely painful. It will change the cornea's normal curvature. This causes a sight impairment haze to appear in the cornea.

In order to get this disease, you must have one parent or both parents be carriers of the gene which causes the disease. What this means a child born to these same parents carries roughly 50% the chance of carrying on this gene or not at all. Roughly 1% of the world’s population has the gene which causes Fuchs’ Corneal dystrophy.

FUCHS ’ CORNEAL DYSTROPHY