Hemaya Maria, Hemaya Monica, Habeeb Amir
Hospital Medicine, Lister Hospital, East and North Hertfordshire National Health Service (NHS) Trust, Stevenage, GBR.
Emergency Medicine, Lister Hospital, East and North Hertfordshire National Health Service (NHS) Trust, Stevenage, GBR.
Cureus. 2023 Jan 11;15(1):e33639. doi: 10.7759/cureus.33639. eCollection 2023 Jan.
Fuchs' endothelial corneal dystrophy (FECD) is progressive corneal endothelium dysfunction, characterised by corneal oedema, and potential blindness if left untreated. Keratoplasty is the only definitive treatment to restore vision in FECD, with different surgical techniques being described. The corneal transplant has been described as the most commonly performed and most successful allogenic transplant globally; therefore, it is crucial to dissect it further since a large proportion of the population worldwide is likely to be impacted. We feel that an updated literature review is both very relevant and necessary at present and aim to amalgamate more recent data on the topic (including meta-analyses, systematic reviews, and randomised control trials (RCTs), among others). We acknowledge that the paucity of reliable data limits progress for FECD and that there are existing ethical complexities in performing prospective trials on patients. Traditionally, the surgery for FECD was limited to penetrating keratoplasty (PK), yet recent developments have introduced more advanced procedures and adapted the existing ones, to provide treatment specific to the disease-affected corneal layers. The questions we will address encompass: how does the severity of FECD govern the treatment options available, what are the differences between PK and types of endothelial keratoplasty (EK), what are the expected clinical outcomes of each of these operations, what are the potential concerns with the idealistic descemetorhexis surgery, and what do we envisage for times to come? Besides this, novel minimally-invasive pharmacological techniques are now being trialled, such as Rho kinase (ROCK) inhibition and cultured endothelial cells (CECs), which may drastically improve the dependence on corneal donors. We examine and critically appraise the literature to explore the understanding of FECD, and the treatment options that exist: historically, currently, and those anticipated for the future.
富克斯角膜内皮营养不良（FECD）是一种进行性角膜内皮功能障碍，其特征为角膜水肿，若不治疗可能导致失明。角膜移植术是恢复FECD视力的唯一确定性治疗方法，目前已有多种不同的手术技术。角膜移植被认为是全球最常进行且最成功的同种异体移植手术；因此，鉴于全球很大一部分人口可能受到影响，进一步剖析该手术至关重要。我们认为目前进行一次更新的文献综述非常相关且必要，旨在整合该主题的最新数据（包括荟萃分析、系统评价和随机对照试验等）。我们认识到可靠数据的匮乏限制了FECD的研究进展，并且对患者进行前瞻性试验存在现有的伦理复杂性。传统上，FECD的手术仅限于穿透性角膜移植术（PK），但最近的发展引入了更先进的手术方法并改进了现有方法，以针对受疾病影响的角膜层进行治疗。我们将探讨的问题包括：FECD的严重程度如何决定可用的治疗选择，PK与各种内皮角膜移植术（EK）之间有何差异，这些手术各自预期的临床结果是什么，理想的后弹力层撕除手术有哪些潜在问题，以及我们对未来有何设想？除此之外，新型微创药理学技术正在进行试验，如 Rho激酶（ROCK）抑制和培养的内皮细胞（CEC），这可能会大幅减少对角膜供体的依赖。我们审视并批判性地评估文献，以探索对FECD的理解以及现有的治疗选择：历史上的、当前的以及未来预期的。
