How Would Nature See Our Corneal Triumphs? The LXXIX Edward Jackson Lecture

Area of Science:

• Ophthalmology
• Corneal Disease Research
• Glaucoma Studies

Background:

• Fuchs dystrophy typically presents with endothelial compromise but minimal stromal edema.
• This clinical presentation contradicts current theories of endothelial cell function and corneal hydration.

Discussion:

• The discrepancy suggests current models of endothelial pumping are insufficient to explain Fuchs dystrophy.
• Alternative hypotheses include secondary endothelial involvement, distinct hydration systems, the cornea contributing aqueous humor, and a link between corneal imbibition pressure and intraocular pressure.
• A potential steroid-hormone dependency in this regulatory system is also proposed.

Key Insights:

• Corneal imbibition pressure appears elevated in Fuchs dystrophy.
• This finding challenges the classification of Fuchs dystrophy as a primary endothelial disorder.
• A novel perspective frames Fuchs dystrophy as a form of "corneal glaucoma."

Outlook:

• Further research is needed to elucidate the proposed shared regulatory system between corneal imbibition and intraocular pressure.
• Investigating the role of steroid-type hormones in corneal hydration regulation is warranted.
• This perspective may lead to new diagnostic and therapeutic strategies for Fuchs dystrophy.