Guttata

Had my yearly eye exam yesterday. I knew I have cataracts and would have to have surgery eventually and apparently the only way they can improve my vision is with the surgery....but..... I evidently have 'guttata' a problem with the endothelial cells of the cornea, With age you have fewer cells and I have exceptionally few and this might get worse with the surgery and develop into Fuchs Dystrophy which doesn't seem to be treatable !!!??? OK says me to the doc. I will wait until I absolutely cannot see then have the cataract surgery. Not so ,says she, then the cataract is so hard she would have to use more ultrasound to remove the lens for longer which would cause more problems with the cells. What is the likelihood of the problem developing into Fuchs Dystrophy and have other people had the cataract surgery with guttata? My mother had an eye removed when she was in her seventies and was losing the sight in her other eye when she died. As she was in England and I was in North America I never knew the reason for this.

[John C Hagan]

There is no exact definition of how many guttatta it takes to diagnosis Fuchs' Endothelial Corneal Dystrophy. Some guttatta are part of aging and do not ever become a problem. Two tests that are often helpful are corneal endothelial cell counts (the number decreases as the disease develops and progresses) and corneal pachymetry (corneal thickness) the thickness increasing as the disease develops and progresses. Family history is useful as many cases of Fuchs' are hereditary (affecting females more than males). Guttata are 'bumps' that develop on the back of the cornea when there are not enough endothelial cells to cover it. These cells are very important as they pump fluid out of the cornea and into the anterior chamber of the eye. The cornea is hydrophilic (water loving) like a sponge. When it swells and gets thicker it starts to become cloudy and blur the vision. When this happens and the impairment is severed than a corneal transplant is indicated. Recently a new operation for decompensated Fuchs' dystrophy called DSEAK (descemet's membrane epithelial automated keratoplasty) has dramatically speeded the healing, safety and results over full thickness penetrating keratoplasty. Corneal endothelial cells do not multiply or replace themselves when damaged or cell death occurs.

Cataract surgery will not cause Fuchs' dystrophy but cataract surgery (or for that matter any surgery inside the eye) will stress the cornea and in severe Fuchs' could be the final straw that causes the cornea to compensate.

Your doctor is absolutely correct. In my patients with progressive Fuchs's dystrophy I recommend cataract surgery SOONER rather than later because the advanced, "hard" cataract will put much more stress and strain on the cornea endothelium than a moderately firm or softer cataract. Fuchs' dystrophy can decompensate on its own without any surgery taking place or any cataract in the eye.

It would be helpful to know if your mother's problem with her eye's was Fuchs' dystrophy. It is unusual for Fuchs' to cause an eye to be removed, so there's a good chance she had something else.

I would go ahead and have the cataract surgery when you vision starts to be a moderate problem for you and the cataract is the cause. By using the endothelial cell count and corneal thickness, your ophthalmologist can give you a reasonable risk of the cornea being able to stand your cataract surgery.

Good luck, new cataract surgical techniques are much, much more gentle on the eye than techniques used in the past.

JCH MD

[JMWB]

My mothers eye removal was 35 years ago . I wonder what treatment was available then or even if it was recognized  Thanks for your reply.!

[John C Hagan]

Fuchs' dystrophy was described in the 1800's so it's been recognized for a long time. The first corneal transplant was performed by Dr. Eduard Zirm on December 7, 1905 in the present-day Czech Republic.

JCH MD