This document discusses Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. It describes the characteristics, classification, pathology, signs, and treatment of Fuchs endothelial dystrophy. It also covers the etiology, clinical features, evaluation techniques including specular microscopy and pachymetry, and management including corneal transplant and conjunctival flap procedures for pseudophakic bullous keratopathy resulting from traumatic endothelial damage following cataract surgery.
2. CHARACTERISTICS OF CORNEAL
DYSTROPHIES
Bilateral, symmetric, inherited, no environmental or
systemic involvement
Early onset, and become clinically apparent until later
Central corneal location
Classified: genetic pattern, severity, histopathologic
features, biochemical characteristic or anatomical
location
4. FUCHS ENDOTHELIAL DYSTROPHY
Bilateral accelerated endothelial cell loss
More common in women
Inheritance: sporadic and AD
Onset: slowly progressive disease in old age ( > 50 ys )
5. PATHOLOGY
Microscopy: endothelial cells larger (polymegathism) &
more polymorphic (pleomorphism) + disrupted by
excrescences of excess collagen in Descemet’s
membrane=>
Dysfunction of endothelial cell => increase corneal swelling
=> reduce Na+
/k+
-ATPase pump
6. FUCHS ENDOTHELIAL DYSTROPHY
Signs:
Cornea guttata
Endothelial
decompensate =>
central stromal edema
and blurred vision, worse
in the morning and
clearing later in the day
7. FUCHS ENDOTHELIAL DYSTROPHY
Signs:
Beaten metal appearance
Develop epithelium edema => persistent edema in the form of
microcysts and bullae
Rupture => pain and discomfort
9. TREATMENT
1. conservative options:
Topical sodium chloride 5% drop or ointment
Reducing IOP
Using hair dryer to speed corneal dehydration in the morning
1. Bandage contact lens:
comfort by protecting exposed nerve endings and flattening bullae
10. TREATMENT
3. Penetrating keratoplasty or Descemet stripping
endothelial keratoplasty ( DSEAK )
Success rate high and not be delayed
4. Other options
Poor vision eye: conjunctiva flaps and amniotic membrance
transplants
14. In cases of TRAUMATIC conditions:
pseudophakic bullous keratopathy:
The resulting endothelium is characterised by decreased cell number
and enlarged and irregularly shaped cells showing polymegathism and
pleomorphism .
When the cell density falls below 200-400 cells/mm2 ,their pump
function begins to fail and stroma begins to swell.
PATHOPHYSIOLOGY
15. CLINICAL FEATURES
Corneal edema
Cornea bullae & Descemet folds
Pain ( rupture of bullae )
Erosive symptoms:
Discomfort, FB sensation, photophobia and watering
Cornea scare and neovascularization
Cystoid macular edema
16. EVALUATION TECHNIQUE
1. Slit- lamp examination
Corneal bullae
Position of IOL
Vitreous touches endothelium
IOP
Fundus examination: Look for CME ( FFA or OCT )
2. Corneal pachymetry (ultrasonic or optic):
measures corneal thickess .[normal:500-550 microns]
If 650 microns suggest a higher risk for edema after intra-ocular surgery
If 700 microns suggest corneal decompensation
17. 3. Specular microscopy
demonstrates reduced endothelial cell density and abnormal
morphology
Its helpful in detecting
`warts or guttae` in fuchs dystrophy
polymegathism and pleomorphism .
EVALUATION TECHNIQUE