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Fuchs dystrophy is a bilateral degenerative disorder of the corneal endothelium. It is a slowly progressive condition with autosomal dominant inheritance and high penetrance. The accumulation of guttae and thickening of Descemet membrane can lead to decreased vision from glare and corneal edema. 1
Endothelial keratoplasty has become a standard treatment for endothelial dysfunction because it provides faster healing and more predictable refractive outcomes compared with penetrating keratoplasty.2--7 Descemet stripping with endothelial keratoplasty (DSEK) is the most commonly performed method of endothelial keratoplasty6 ; however, DSEK also transplants a variable amount of donor stromal tissue, so it is difficult to accurately evaluate tomographic changes in the recipient cornea after surgery. Descemet membrane endothelial keratoplasty (DMEK) is a new iteration of endothelial keratoplasty that removes and replaces only the endothelial cell layer and Descemet membrane. 3--7 Because no stroma is transplanted during DMEK, eyes that have undergone DMEK allow direct assessment of the changes that occur in the recipient corneal stroma with resolution of chronic corneal edema.
Corneal tomography using the Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) creates a three-dimensional reconstruction of the cornea with rotating Scheimpflug photography. Several studies have shown the repeatability of this technology.8--10 In this study, the Pentacam was used to evaluate corneal thickness and anterior and posterior surface changes before and after DMEK. To our knowledge, this is the first study of how long-standing corneal edema resolves in human patients following replacement of dysfunctional corneal endothelium with a single healthy endothelial cell and Descemet membrane layer from a donor cornea.
Patients and Methods
This was a prospective study of corneal tomography in eyes with Fuchs dystrophy treated with DMEK at Price Vision Group, Indianapolis, Indiana. Twenty-eight of 35 patients who underwent a primary DMEK procedure between July 30, 2008 and January 7, 2009, agreed to participate; 2 patients had bilateral procedures in that time period and both eyes were included. An independent review board, IRB Co, approved the study and patients read and signed an informed consent document. The work was compliant with the Health Insurance Portability and Accountability Act of 1996.
Surgical Procedure
The surgical procedure has been described previously.5,7 Briefly, the Descemet membrane was stripped off a 6- to 7-mm area of the recipient...