Medical and Semi-surgical Treatments for Fuchs Endothelial Corneal Dystrophy

Abstract

Unraveling the genetic mechanisms of Fuchs endothelial corneal dystrophy has opened new possibilities for future targeted medical therapy of the disease. Until these possibilities mature, regenerative semi-surgical approaches by cell injection or cell sheet transfer could help expand the donor pool, and possibly enable autologous transplantation. Descemet membrane stripping alone and acellular Descemet membrane transfer are more immediate surgical approaches that could be temporary treatments in some patients, though there is a lack of understanding of the factors that predict success for these procedures. Regardless of approach, clinical trials will be necessary, and clinicians should therefore try to standardize their methods of assessing disease severity and the outcomes of intervention.

Zusammenfassung

Ein Verständnis der genetischen Grundlagen der Fuchs-Endotheldystrophie eröffnet die Möglichkeit zukünftiger gezielter, nicht operativer Therapien. Bis diese Therapien ausgereift sind, könnten neue regenerative therapeutische Ansätze wie die Injektion von Endothelzellen oder der Transfer kultivierter Endothelzellschichten helfen, die Verfügbarkeit von Donorgewebe zu verbessern und vielleicht sogar autologe Transplantationen zu ermöglichen. Eher temporäre operative Ansätze für ausgewählte Patienten sind das alleinige Stripping und der azelluläre Transfer der Descemet-Membran, obgleich unklar ist, welche Patienten am meisten von diesen Verfahren profitieren können. Für alle Behandlungsverfahren werden klinische Studien notwendig sein, weshalb Kliniker anstreben sollten, die Bestimmung des Schweregrads der Fuchs-Endotheldystrophie und der postoperativen Erfolgsparameter zu standardisieren.

Key words

endothelial keratoplasty - Fuchs endothelial corneal dystrophy - trinucleotide repeat expansion - TCF4 gene - ROCK inhibitor - cell injection

Schlüsselwörter

Endothelzelltransplantation - Fuchs-Endotheldystrophie - Trinukleotid-Repeat-Expansion - TCF4-Gen - ROCK-Inhibitor - Zellinjektionen

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