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A.B. Pittard, G.K. Klintworth, A. Siddiqui, N.A. Afshari; Fuchs Endothelial Dystrophy: Thirty Years of Experience with Penetrating Keratoplasty (1972-2001) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3864.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: A comprehensive review of individuals with Fuchs dystrophy who underwent penetrating keratoplasty (PK) over a 30-year period. Methods: Of 710 patients with Fuchs dystrophy diagnosed histopathologically at Duke University Medical Center following PK we reviewed all available clinical records (225 patients). We recorded the age, gender, visual acuity, preoperative clinical diagnosis, and family history of these patients at the time of PK. We analyzed a subgroup of these patients who had undergone a prior cataract extraction (CE) to determine its role in the progression of Fuchs dystrophy. Results: Females represented 78.2% of the patients. The female to male ratio was >3 to 1. The mean age at which a patient with Fuchs dystrophy underwent PK was 66.5 yrs. Bilateral PK was required on 33% of the patients. Preoperatively, 74% of operated eyes had a visual acuity of <20/40 and 26% were worse than 20/100. Out of 213 patients from whom family histories were available, 16.9% were positive for one or more blood relatives who were known to have Fuchs dystrophy or to have undergone a PK. In a group of patients who had PK on both eyes and CE on one eye, the eye that underwent CE required PK on average 2.2 years earlier than the fellow eye. In patients undergoing unilateral PK, who had prior CE, 75% of the CE's were in the eye having PK, while 25% of the CE's were in the non-PK eye. The average time from CE to PK was 5.8 yrs. Only 4.4% of eyes required repeat PK. 5.8% of eyes diagnosed histopathologically with Fuchs dystrophy were diagnosed clinically as pseudophakic bullous keratopathy. Conclusions: This study, which involves to our knowledge the largest volume of patients with Fuchs dystrophy to date, affirms that Fuchs dystrophy is a disorder of aging that predominantly affects females and that it is often familial. Cataract extraction in an eye with Fuchs dystrophy can lead to corneal decompensation requiring PK at an earlier age than in the fellow eye. The clinical diagnosis of Fuchs dystrophy may be difficult in an eye that develops post-operative corneal edema and bullous keratopathy following a CE.
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