DWEK for Fuchs Dystrophy: When Less Is More

Corneal clearance and migration of peripheral endothelial cells to the center after descemetorrhexis have been reported in Fuchs dystrophy. This video describes the  technique of descemetorrhexis without endothelial keratoplasty (DWEK) as a treatment for symptomatic Fuchs endothelial dystrophy. Combined phacoemulsification, posterior chamber lens implantation, and a 4-mm central descemetorrhexis were performed. Inclusion criteria were visual acuity (VA) less than 20/50 andadvanced central guttae with healthy peripheral endothelial cells and cataract. Ripasudil (Glanatec 0.4%) was used as an adjuvant in slow responders. Corneal clearance was observed after 3 months postoperatively, with significant improvement in VA. Endothelial cell migration and repopulation was confirmed by specular microscopy. Anterior segment OCT showed recovery of corneal thickness to normal values.