Improving patient-centered outcomes in Fuchs endothelial corneal dystrophy with reliable assessment of preoperative disease severity and corneal morphology

• Applicant: Dr. Katrin Wacker
• Subject Area: Ophthalmology
• Term: from 2020 to 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 440526480

Fuchs endothelial corneal dystrophy is the most common indication for corneal transplantation. Endothelial keratoplasty allows for less invasive surgery by replacing the diseased endothelium only. Currently, it is not clear when to perform endothelial transplantation. Early in the course of the disease, corneal remolding starts in all corneal layers, not only the diseased endothelium that is replaced by surgery. This remodeling causes characteristic visual disability.This project aims at improving diagnosis of early changes in Fuchs dystrophy, predicting patient-relevant outcomes after endothelial keratoplasty, and understanding the cellular basis of corneal remodeling.1. RELIABLE DIAGNOSIS. Patients with Fuchs dystrophy characteristically report on cloudy vision in the morning that clears up as the day progresses. This study will quantify changes in the corneal morphology and in vision over the course of the day in Fuchs dystrophy and normal eyes. The study aims at identifying the impact of diurnal variation on routine clinical diagnostics and whether the time of the day needs to be considered in disease staging. These results will help improving diagnostic reliability and understanding subjective diurnal variation in Fuchs dystrophy patients. 2. VISUAL DISABILITY BEFORE AND AFTER ENDOTHELIAL KERATOPLASTY. This prospective study will investigate which clinical and optical factors predict visual disability after endothelial keratoplasty. V-FUCHS, our newly developed questionnaire specific for Fuchs dystrophy, will be used to assess visual disability. These results will improve preoperative assessment of disease severity and help find the optimal timing for surgical intervention before the cornea is too altered for endothelial keratoplasty to successfully improve vision.3. DYSFUNCTIONAL PERIPHERAL ENDOTHELIAL CELLS IN FUCHS DYSTROPHY. Experimental therapeutic approaches are testing the removal of disease central endothelial cells, relying on the function of the remaining peripheral endothelial cells. This project will assess if functional impairment of peripheral endothelial cells can be predicted using preoperative measures of disease stage. The data will elucidate to what degree peripheral endothelial cells are altered in Fuchs dystrophy and which corneas are unlikely to clear after removal of central endothelial cells.RESULTS FROM THIS PROJECT will improve routine diagnostic of Fuchs dystrophy, optimize the timing of surgical intervention, and elucidate the functional basis of inter-individual variability and may point to novel mechanism-based approaches to Fuchs dystrophy diagnosis and treatment.

• DFG Programme: Research Grants