Treatment of Fuchs Disease: Review of Clinical Trials

Abstract

Background: Fuchs corneal endothelial dystrophy (FECD) is a genetically heterogeneous disease, accompanied by irreparable damage to the corneal endothelium. FECD is characterized by thickening of Descemet's membrane, with accelerated loss of endothelial cells initially in the center of the cornea and later in its periphery. A mosaic defect of the endothelium of the corneal surface in which cells respond with proliferation and migration, resulting in non-uniform abnormalities in size (polymegatism) and variations in hexagonal shape (pleomorphism). The most recent International Classification of Corneal Dystrophies categorizes FECD into two types: 1 - early-onset FECD (rare); and 2 - late-onset FECD (most common). Aim: To carry out a literature review to synthesize the clinical evidence related to the treatments of FECD. Method: Papers were selected in PubMed databases using the following search strategy: fuchs[title] AND dystrophy[title]. Only clinical trials published in the last five years were considered in this review. Results: Eleven articles were selected that adequately discuss treatments and disease management strategies. Synthesis of the Evidence: The main method of treatment for FECD is Descemet's membrane endothelial keratoplasty (DMEK), considered the gold standard for the management of disease. In addition, several tools and strategies capable of improving the parameters related to the procedure, or even allowing the evaluation of the evolution of teaching, are presented.