Fuchs' endothelial corneal dystrophy (FECD) is caused by progressive loss of corneal endothelial cells. The gold-standard surgical treatment when visual acuity drops below 6/18 from corneal edema is:
- A Descemet membrane endothelial keratoplasty (DMEK) ✓
- B Penetrating keratoplasty (PKP)
- C Deep anterior lamellar keratoplasty (DALK)
- D Superficial anterior lamellar keratoplasty (SALK)
Explanation
FECD is an endothelial disease — the stroma and Bowman's layer are healthy. Descemet membrane endothelial keratoplasty (DMEK), which selectively replaces only the Descemet membrane and endothelium (approximately 10–15 μm), is the gold standard for endothelial diseases because it provides faster visual rehabilitation, superior visual outcomes (BCVA approaching 6/6 in many patients), and lower rejection rates than DSAEK or PKP. DALK replaces stroma down to Descemet but leaves endothelium in place — not appropriate for FECD. SALK addresses superficial stromal/Bowman pathology only. PKP is a full-thickness transplant that is now second-line due to higher complication rates.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.