Fuchs Dystrophy is a disease of the endothelial cells (the most inner cell layer) of the cornea. The most important function for these cells is to pump fluid out of the cornea. There is always a tendency for the cornea to be imbibed with fluid, due to the hydrostatic forces from inside the eye and the retention of fluid when your eyes are closed during sleep. People with Fuch’s corneal dystrophy have an impaired ability to pump out the fluid build of in the cornea and some will exhibit a thicker swollen cornea with cloudy vision from that swelling. Also, patients with this disease can be seen to have outgrowths from the corneal laye just adjacent to the endothelial cells, and can be seen on slit lamp examination. This is seen as a beaten metal appearance (called guttata) on slit lamp examination. These outgrowths can cause symptoms of glare, especially during activities such as night driving.
Fuchs dystrophy is a progressive disease, but may never actually be symptomatic. If this is the case, no intervention is needed. If it does become vision threatenting, a great surgical option is a Descemet Membrane Endothelial Keratoplasty (DMEK).
This type of surgery entails replacing the inner two layers of the cornea (the endothelial cells and descemet membrane). This is the thinnest possible cornea transplant! The advantage of DMEK is less trauma to the eye during surgery, faster recovery and healing, and less rejection of the graft. However, there are cases where DMEK is not possible and one must do a different type of transplant.