Descemet Stripping Only for Symptomatic Fuchs Endothelial Dystrophy—A Retrospective Case Series Comparing ROCK-I vs. Hypertonic Sodium Chloride for Post-Surgical Adjuvant Therapy

TL;DR

This study shows that Descemet stripping only (DSO) can improve vision in patients with Fuchs endothelial dystrophy, with similar outcomes using ROCK inhibitors or hypertonic sodium chloride.

Contribution

The paper presents a novel retrospective case series evaluating DSO as a treatment for Fuchs dystrophy with adjuvant therapies.

Findings

All eyes achieved corneal clearance within an average of 7.2 weeks.

Visual acuity improved in 11 out of 13 eyes after the procedure.

ROCK inhibitors showed a trend toward faster clearance and higher cell counts, though not statistically significant.

Abstract

Purpose: To report our experience with Descemet stripping only (DSO) for the treatment of Fuchs endothelial corneal dystrophy. Methods: Thirteen eyes of 9 patients with symptomatic Fuchs endothelial dystrophy underwent a 4 mm central Descemetorhexis without graft implantation between June 2017 and July 2020. All patients had central confluent guttata, undetectable central endothelial cell count by specular microscopy, and healthy peripheral corneal endothelium. In 6 eyes, the procedure was combined with phacoemulsification and intraocular lens implantation. Eight eyes were treated with topical rho-associated protein kinase (Rock) inhibitors and five eyes were treated with hypertonic sodium chloride 5%, post operatively. Results: All eyes completed at least 4 months of post-operative follow-up (mean follow-up 12.0 ± 7.9 mo; 4–29 mo). Mean patient age was 70 ± 6 years. All eyes achieved corneal clearance with an average time for clearance of 7.2 ± 2.4 weeks. Mean endothelial cell count postoperatively was 778 ± 228. Mean central corneal thicknesses pre- and postoperatively were 620 ± 100 and 560 ± 58 μm, respectively. Eleven eyes achieved improvement in visual acuity and in two eyes vision remained unchanged, with mean visual acuity 0.392 to 0.225 logMAR; p = 0.001. Also, all patients reported subjective improvement in the quality of vision. ROCK inhibitors compared to hypertonic sodium chloride 5% did not show statistically significant differences in time for corneal clearance or endothelial cell counts postoperatively but did show a trend towards faster corneal clearance and higher endothelial cell counts postoperatively among the ROCK inhibitors-treated eyes. Conclusions: In patients with Fuchs endothelial dystrophy and visual degradation secondary to central guttata, DSO represents a viable procedure for visual rehabilitation.