# Emerging Innovations in the Treatment of Fuchs Endothelial Corneal Dystrophy: A Narrative Review

## TL;DR

This review explores new treatments for Fuchs endothelial corneal dystrophy, focusing on improving surgical techniques and regenerative therapies to restore vision.

## Contribution

The paper provides a comprehensive overview of emerging therapies and innovations for FECD treatment.

## Key findings

- DMEK is the gold-standard surgery for FECD but faces challenges like donor shortages and a steep learning curve.
- Regenerative approaches like cultured endothelial cell injection and synthetic corneal substitutes are promising.
- Future treatments may combine advanced surgical techniques with cell-based and biomaterial solutions.

## Abstract

Fuchs endothelial corneal dystrophy (FECD) is the leading cause of endothelial failure requiring keratoplasty in industrialised nations. Descemet membrane endothelial keratoplasty (DMEK) has become the gold-standard surgical therapy, yet it is constrained by limited donor tissue and a steep learning curve. This narrative review summarises current and emerging therapeutic strategies for FECD. We describe conventional endothelial keratoplasty and its outcomes, tissue-sparing procedures such as descemetorhexis without endothelial keratoplasty (DWEK) and quarter-DMEK, regenerative approaches including cultured endothelial cell injection and synthetic corneal substitutes, and adjunctive innovations ranging from Rho-associated kinase inhibitors to artificial intelligence-assisted diagnostics. Challenges surrounding donor shortages, variable clinical outcomes, regulatory hurdles and cost are critically appraised. We conclude by outlining future directions that are likely to combine advanced surgical techniques with cell-based and biomaterial solutions to deliver accessible, long-term restoration of vision for patients with FECD.