Fuchs' corneal dystrophy

Fuchs' Corneal Dystrophy (FCD) is a slowly progressing corneal dystrophy that usually affects both eyes and is slightly more common in women than in men. It is named after the Austrian ophthalmologist Ernst Fuchs, who first described the condition in 1910. Fuchs' Corneal Dystrophy is characterized by the degeneration of the endothelial cells of the cornea, leading to the accumulation of fluid within the cornea (corneal edema) and resulting in vision impairment or loss.

Symptoms and Diagnosis

The disease typically has a late onset, with symptoms often not appearing until the 5th or 6th decade of life. Early symptoms may include glare and sensitivity to light, as well as blurry or cloudy vision, especially in the morning. As the condition progresses, swelling of the cornea may lead to pain and further reduction in vision.

Diagnosis of Fuchs' Corneal Dystrophy is primarily based on clinical examination by an ophthalmologist. This may include a slit-lamp examination, which allows the doctor to see the characteristic changes in the cornea, such as guttata, which are small, wart-like bumps on the back of the cornea.

Causes and Genetics

The exact cause of Fuchs' Corneal Dystrophy is not fully understood, but it is known to have a genetic component. Mutations in several genes, including COL8A2, TCF4, and ZEB1, have been associated with the condition. It is believed to be inherited in an autosomal dominant manner, meaning that only one copy of the altered gene is necessary to increase the risk of developing the disease.

Treatment

There is no cure for Fuchs' Corneal Dystrophy, but treatment is available to manage symptoms and slow progression. In the early stages, treatments may include saline solutions or ophthalmic ointments to draw fluid out of the cornea and reduce swelling. As the disease progresses, more invasive treatments may be necessary. The most effective treatment for advanced Fuchs' Corneal Dystrophy is corneal transplantation. Two main types of corneal transplant procedures are used: penetrating keratoplasty (PK) and endothelial keratoplasty (EK), with EK being the preferred method due to its faster recovery times and lower risk of complications.

Prognosis

The prognosis for individuals with Fuchs' Corneal Dystrophy varies. With early detection and treatment, many people can maintain good vision for years. However, as the disease progresses, corneal transplantation may become necessary to restore vision.

Epidemiology

Fuchs' Corneal Dystrophy is relatively common, affecting approximately 4% of people over the age of 40 in the United States. It is more prevalent in women than in men and tends to have a higher incidence in certain families, supporting the genetic component of the disease.