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Abstract

We thank Bleyen et al for their interest in our article. We agree that Balachadran et al1Balachandran C. Ham L. Verschoor C.A. et al.Spontaneous corneal clearance despite graft detachment in Descemet membrane endothelial keratoplasty.Am J Ophthalmol. 2009; 148: 227-234Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar reported similar corneal clearing despite detached Descemet's membrane endothelial keratoplasty tissue. The 2 unique features of our case were (1) corneal clearing despite no tissue implantation in 1 eye, and (2) the concomitant diagnoses of posterior polymorphous dystrophy (PPMD) and Fuchs' dystrophy in our patient.2Shah R.D. Randleman J.B. Grossnikalus H.E. Spontaneous corneal clearing after Descemet's stripping without endothelial replacement.Ophthalmology. 2012; 119: 256-260Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar Our patient was also quite young (34 years old), and we speculated that either her diagnosis (PPMD), young age, or a combination of both likely facilitated host endothelial cell central repopulation. At latest follow-up, 2.5 years after surgery, our patient has maintained uncorrected distance visual acuity of 20/25 bilaterally and clear corneas. One of the cases reported by Balachadran et al1Balachandran C. Ham L. Verschoor C.A. et al.Spontaneous corneal clearance despite graft detachment in Descemet membrane endothelial keratoplasty.Am J Ophthalmol. 2009; 148: 227-234Abstract Full Text Full Text PDF PubMed Scopus (117) Google Scholar was also relatively young (47 years) old, and neither of their cases had histopathologic examination reported; thus, we have no way of knowing whether or not either of these individuals had concomitant PPMD, although this would be unlikely. The results of the pilot study that Bleyen et al report are disappointing, but not surprising for patients with isolated Fuchs' dystrophy. We feel it is unlikely that Descemet's membrane stripping alone is sufficient for most patients with Fuchs' dystrophy. It would have been beneficial for the authors to report the age range of their patients to determine whether younger age was associated with increased corneal clearing in the 3 patients with initially positive response and their one patient with a good outcome from Descemet's membrane stripping only. In our report, we specifically never mentioned or encouraged the possibility that this technique might be applicable to patients with isolated Fuchs' dystrophy. Rather, we hypothesized that a subset of patients with PPMD might be candidates for such a procedure. Although PPMD is a significantly less common disorder, it would be of great interest to conduct a similar pilot study in patients with PPMD to the one reported here in patients with Fuchs' dystrophy. We agree with Bleyen et al that further genetic studies may improve our ability to determine which patients may respond to Descemet's stripping alone, and we encourage those researchers actively involved in this field to keep working towards that goal.3Gottsch J.D. Sundin O.H. Liu S.H. et al.Inheritance of a novel COL8A2 mutation defines a distinct early-onset subtype of Fuchs corneal dystrophy.Invest Ophthalmol Vis Sci. 2005; 46: 1934-1939Crossref PubMed Scopus (158) Google Scholar, 4Kelliher C. Chakravarti S. Vij N. et al.A cellular model for the investigation of Fuchs' endothelial corneal dystrophy.Exp Eye Res. 2011; 93: 880-888Crossref PubMed Scopus (15) Google Scholar, 5Louttit M.D. Kopplin L.J. Igo Jr, R.P. et al.FECD Genetics Multi-Center Study GroupA multicenter study to map genes for Fuchs endothelial corneal dystrophy: baseline characteristics and heritability.Cornea. 2012; 31: 26-35Crossref PubMed Scopus (53) Google Scholar We further encourage all physicians who examine patients with atypical Fuchs' and/or concomitant Fuchs' and PPMD to contact the investigators and see if genetic testing may be of value both to improve our overall understanding of these diseases as well as perhaps helping to determine prognosis and target specific treatment protocols for these individuals. Spontaneous Corneal Clearing after Descemet's StrippingOphthalmologyVol. 120Issue 1PreviewWe read the article by Shah et al1 with much interest. We agree with the authors that it is very interesting to see spontaneous corneal clearing after Descemet's stripping without endothelial replacement in their patient with a dual diagnosis of Fuchs' endothelial dystrophy and posterior polymorphous membrane dystrophy. Host endothelial migration could be a possible mechanism for this central endothelial cell repopulation. Balachadran et al2 previously described corneal clearing with improved visual acuity in 2 eyes of 2 patients with Fuchs' dystrophy after Descemet's membrane endothelial keratoplasty despite early donor detachment. Full-Text PDF