Guttata cornea and Fuchs’ dystrophy are two ophthalmology pathologies that mainly affect women over 40 years of age with a family history.
Guttata cornea is the initial alteration of Fuchs’ dystrophy, a corneal disease that presents several stages. It is a common pathology that usually affects both eyes. It is characterized by a loss of the cells of the innermost layer of the cornea: the endothelium.
The cornea has 5 layers:
- Epithelium
- Bowman’s membrane
- Stroma
- Descemet’s membrane
- Endothelium
Fuchs’ dystrophy is more frequent in women. In half of the cases, there is a family history of this disease. It presents from the age of 40 years onwards in a slowly progressive manner.
How does Fuchs’ dystrophy progress?
Fuchs’ dysphoria progresses in four phases: corneal guttate, corneal edema, bullous keratopathy and fibrosis.
- In the corneal guttate phase the patient usually does not notice any symptoms. However, on examination the ophthalmologist finds dark spots in the form of drops that are located in the innermost layer of the cornea: the endothelial layer. These “droplets” increase and progressively spread from the central part of the cornea towards the periphery. In addition, there are also accumulations of microscopic brown pigment dots.
- In the second stage of Fuchs’ dystrophy, corneal edema appears: excess fluid accumulates progressively in the cornea. This causes a loss of transparency of the cornea and the patient notices a decrease in vision.
- Bullous keratopathy: when epithelial edema is persistent, microscopic bullae (blisters) form in the epithelium, which subsequently rupture and cause corneal ulcers and pain.
- In the final stage, fibrosis occurs in the stroma. These are “scars”, which are not transparent and cause blurred vision.
How can it be treated?
In the initial stages of corneal guttate and mild corneal edema, antiedema eye drops and ointments are used. In more advanced stages, the current surgical treatment is endothelial transplantation. Good results are obtained in most cases. It consists of replacing the diseased endothelium with healthy endothelium from a deceased donor.
The two types of endothelial transplantation are: DSAEK (Descemet Stripping automated endothelial Keratoplasty) and DMEK (Descemet Membrane endothelial Keratoplasty).