New Fuchs dystrophy treatment / Descemet’s membrane removal - A State of Sight # 118

A new surgical option is available for patients with Fuchs endothelial dystrophy - Descemet's membrane removal. This was recently described by Kathryn Colby, MD, PhD from The University of Chicago.

Unlike the current modern operations for Fuchs dystrophy (DSEK and DMEK), in this procedure Descemet's membrane is removed from the back of the cornea, and no corneal graft is placed afterwards. Watch this episode of A State of Sight with Isaac Porter, MD to learn more about this innovative new option.

Welcome to A State of Sight, I’m Isaac Porter, MD and this is your update in ophthalmology and eye care from Raleigh. Today, I would like to cover a new, innovative technique for surgically managing patients with Fuchs endothelial dystrophy, Descemet’s membrane removal.

This was recently popularized by Kathryn Colby, MD, PhD from the University of Chicago. She is an excellent corneal surgeon, and has presented a new operation where Descemet’s membrane can be removed at the time of cataract surgery without placing a corneal graft afterward to help improve vision.

In Fuchs dystrophy, the cornea becomes cloudy and swollen because the back layers do not work properly. Also, this layer is not smooth, causing glare that interferes with vision.

To understand this new method better, first consider what we currently do for patients with Fuchs dystrophy. With an inner layer corneal transplant (DSEK or DMEK), Descemet’s membrane is removed from the back of the cornea and a corneal graft is replaced in this area, helping to clear the cornea and to improve vision.

In the new operation, instead of removing Descemet’s membrane and placing a graft, Dr. Colby has started removing Descemet’s membrane and not placing a graft. After surgery, it appears that the remaining endothelial (inner layer) cells on the back of the cornea move towards the center of the cornea and fill the bare area.

Weeks later, the cornea clears when the cells are able to do their job of pumping fluid out of the cornea back into the eye. This is needed to keep the cornea thin and clear so light can pass into the eye evenly for good vision.

Descemet’s membrane is only removed from the central 4mm zone of the cornea with this procedure. On average, the cornea is about 12mm in diameter, so by removing only the central 4mm zone, a lot of the total area of the cornea peripherally is undisturbed. This outer ring provides cells to migrate centrally.

You may have heard that based upon total area, a large or extra large pizza is a better value than a medium pizza because of the relative size. In the larger sizes, even though the diameter only increases a little, the whole area of the pizza goes up significantly.

This same effect is working to our advantage in the opposite direction when we remove a small central 4mm zone of the cornea. Not a lot of the total corneal area has been removed and a larger surrounding area remains to help it to heal and clear over time.

The recovery is slower than the current techniques of DSEK and DMEK (Descemet’s Stripping Endothelial Keratoplasty and Descemet’s Membrane Endothelial Keratoplasty) because it takes longer for the cornea to clear. Also, this new operation did not work for all patients and some eventually required a transplant.

As we learn more about this technique and more surgeons perform it, I believe that it will be a great and widely accepted option in the future. If you have any questions about Descemet’s membrane removal, please post and we will be happy to answer them. We hope to see you again soon next time on A State of Sight.

If you have Fuchs dystrophy and cataracts interfering with your vision, contact our office at 919-876-4064 to schedule an evaluation to see if this new procedure may be an option for you.