10-Year outcome of descemet stripping only in a patient with Fuchs endothelial dystrophy: a case report

In recent years, descemet stripping only (DSO) has emerged as an alternative to descemet membrane endothelial keratoplasty (DMEK) in certain patients with Fuchs endothelial dystrophy (FED). We herein report the 10-year follow-up of a 77-year-old male patient after bilateral DSO. The patient initially underwent DSO on the right eye for circumscribed cornea guttata. Three weeks after DSO, the best-corrected visual acuity (BCVA) already increased from 0.5 logarithm of the Minimum Angle of Resolution (logMAR) [Endothelial Cell Density (ECD) 1667/mm², Central Corneal Thickness (CCT) 583 µm] to 0.2 logMAR, and further improved to 0 logMAR 1 year after surgery (ECD 2213/mm², CCT 567 µm). This excellent visual acuity remained stable over the following 5 years (ECD 1696/mm², CCT 568 µm). Five years after the successful surgery on the right eye, DSO was also performed on the left eye by the same surgeon as FED progressed, with BCVA dropping to 0.5 logMAR (ECD unmeasurable, CCT 703 µm). However, this time, the treatment did not improve vision. Consequently, a DMEK was performed 7 months after DSO, which increased the BCVA to 0.1 logMAR. Ten years after successful DSO of the right eye, corneal guttata were observed, indicating de novo formation of a descemet membrane, and vision deteriorated again to 0.2 logMAR (ECD not measurable, CCT 641 µm). DMEK was also performed on the right eye ten years after successful DSO, which improved vision to 0.2 logMAR at one-year follow-up. This case suggests that DSO may be a temporary alternative to DMEK in FED, potentially providing excellent visual gain and good central endothelial cell density for nearly ten years. However, it may still fail due to long-term progression of the disease. It also highlights that the outcome may be limited by individual factors. Therefore, it is crucial to educate the patient about the limitations of DSO, both in short and long term. Nevertheless, if DSO fails, endothelial keratoplasty can still be successfully performed.