A 35-year-old patient is diagnosed with Fuchs endothelial corneal dystrophy (FECD). Specular microscopy shows endothelial cell count of 950 cells/mm² (normal >2000) with pleomorphism and polymegethism. What is the GOLD STANDARD treatment at this stage when the patient develops significant corneal edema reducing vision to 6/36?
- A Descemet membrane endothelial keratoplasty (DMEK) ✓
- B Penetrating keratoplasty (PKP)
- C Deep anterior lamellar keratoplasty (DALK)
- D Hypertonic saline drops and bandage contact lens
Explanation
FECD is an endothelial dystrophy (type IV collagen and SLC4A11 mutations among others) causing progressive endothelial failure, guttata formation, and eventual corneal edema. DMEK (Descemet membrane endothelial keratoplasty) has become the gold standard, replacing Descemet stripping automated endothelial keratoplasty (DSAEK) and PKP. DMEK transplants only the Descemet membrane + endothelium (without stroma), resulting in faster visual rehabilitation, fewer rejections, and better visual outcomes (often 6/6 or 6/9). DALK does not address endothelial pathology. Hypertonic saline is temporizing.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.