Fuchs' Dystrophy

Fuchs' dystrophy is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men. Although doctors can often see early signs of Fuchs' dystrophy in people in their 30s and 40s, the disease rarely affects vision until people reach their 50s and 60s.
The cornea is the clear, round, "window" of tissue that allows light to enter the front of the eye. In a normal, healthy cornea, the endothelial cells make up the innermost layer.  These cells pump fluid out of the cornea in order to keep it clear.  In Fuchs’ dystrophy, there is a deterioration of these cells and a reduction of the natural pumping activity of the cornea without any apparent reason.  As more endothelial cells are lost over the years, the remaining endothelial cells become less efficient at pumping fluid.  Excess fluid begins to accumulate, causing the cornea to become swollen and less transparent which leads to vision distortion.  
As the disease progresses, the fluid may slowly spread throughout the layers of the cornea and accumulate under the outermost layer of the cornea, called the epithelium.  Epithelial swelling damages vision by changing the cornea's normal curvature, and causing a sight-impairing haze to appear in the tissue. The epithelial swelling may also produce tiny blisters on the corneal surface.  When these blisters burst, they may cause pain and irritation. 

Symptoms:

•    Glare and blurred vision.  Vision is typically worse upon awakening and gradually clears during the day. This happens because the cornea is normally thicker in the morning; it retains fluids during sleep that evaporate while we are awake and our eyes are open.  As the disease worsens, this swelling will remain constant and reduce vision throughout the day.
•    Possibly severe pain (if blisters burst)

Treatment:

•    Drops and/or ointments to reduce swelling
•    May gently blow warm air from a hairdryer at arm’s length toward eyes for a few minutes every morning to dehydrate the cornea
•    When the disease interferes with daily activities, a person may need to consider having a corneal transplant to restore sight. 

Corneal Transplant with DSAEK:

Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) is small-incision corneal transplant surgery.  In DSAEK, only the diseased endothelial layer of the cornea is removed and replaced.  Compared to traditional cornea transplantation, there is a smaller wound with faster healing, faster visual recovery, decreased incidence of rejection and fewer visits to the doctor after surgery.