Cornea — endothelium

Fuchs’ dystrophy: when the cornea clouds over, and the DMEK graft

The deepest layer of the cornea, the endothelium, acts like a pump that keeps the cornea transparent by removing water. In Fuchs’ dystrophy these cells wear out: the cornea swells and becomes hazy. The DMEK graft replaces this single layer. Seen in cross-section, as on an OCT examination.

Cross-section of the cornea (OCT view)

OCT cross-section of the cornea and its endothelium Curved cross-section of the cornea, OCT style: epithelium at the surface, stroma in the middle, endothelium deep down. In Fuchs’ disease the endothelium deteriorates and the stroma swells; the DMEK graft replaces it. epithelium (surface) stroma endothelium (the pump)

Key

Endothelium — the deep pump that keeps the cornea clear.
Stroma — the main thickness of the cornea.
Guttata — small outgrowths, a sign of Fuchs’ disease.
Transparency

The DMEK graft replaces only a thin layer of the cornea (and not its whole thickness): recovery is generally simpler. The indication is decided case by case, depending on the discomfort and the state of the cornea.

Educational diagram — Dr Moïse Tourabaly, ophthalmologist. For information purposes; does not replace an examination.