Fuch's endothelial corneal dystrophy progresses through four stages. The sequence of pathological events in correct order is:

• A Stromal edema → guttata → bullae → pannus formation
• B Bullae → guttata → stromal edema → endothelial failure
• C Subepithelial fibrosis → guttata → stromal edema → bullous keratopathy
• D Guttata → stromal edema → epithelial bullae → subepithelial fibrosis and vascularization ✓

Explanation

Fuchs' dystrophy progresses in sequence: Stage 1 — central guttata (excrescences on Descemet's membrane) without symptoms; Stage 2 — stromal edema (stromal cloudiness and Descemet's folds) with early morning blur; Stage 3 — epithelial bullae (bullous keratopathy) causing pain, photophobia, and reduced vision; Stage 4 — subepithelial fibrosis and vascularization reducing corneal sensation and pain (paradoxical improvement in pain but permanent vision loss). Treatment options include endothelial keratoplasty (DSAEK/DMEK) before Stage 3.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.