March 22, 2018

Healthier Corneas: A Patient Case of Fuch’s Endothelial Dystrophy


Several months ago, a 74 year-old female presented with symptoms of blurred vision, sometimes-painful foreign body sensation, and frequent tearing while reading. Her ocular history is positive for Fuch’s Endothelial Dystrophy and was treated by a combination of Muro-128 ointment hs, and Muro 128 solution b.i.d. daily. She applies non-preserved artificial tears prn, which provides temporary relief for her discomfort. As an avid reader, she was seeking relief to pursue one of her favorite activities and better quality of life. Initial examination results included:

  • BCVA OD 20/50, OS 20/40– Attainment of VA notable for frequent pauses as the patient attempted to correctly identify letters on the Snellen chart.
  • Corneas positive for reduced cell count, moderate to severe edema, bullae, significant positive fluorescein staining, and highly irregular, unstable ocular surface wettability. Ptosis bilaterally, negative per notable lid margin pathology.
  • Fundus examination unremarkable for pathology.
  • IOL stable and clear OU.
  • IOP 13 OD, 14 OS Goldmann tonometry.

At the conclusion of the examination, I explained that our treatment plan would be directed towards reduction of the symptoms stemming from the complications of the disease process of the Fuch’s Dystrophy. I shared our first-hand observations of the healing power of Prokera®. I also told her I felt that this treatment would reduce the magnitude of her symptoms, and thus enable her to read more comfortably.

Recommendation: Application of Cryopreserved Amniotic Membrane (Prokera), for both eyes.

We chose to treat the patient’s right eye on her next visit. Entering BCVA was 20/50; pre-treatment corneal appearance was consistent with our initial examination. Prokera Slim was applied. We scheduled its removal in five days and instructed her to apply her lubricants as often as desired. As scheduled, the patient returned five days later for removal of the Prokera. After its removal, we examined the cornea of the right eye, and observed a reduction in fluorescein staining, as well as improved ocular surface integrity. Visual acuity was 20/40. She was scheduled for a follow up visit one week later and an application of Prokera Slim to the left eye.

The patient returned and prior to treatment of the left eye, we re-examined the cornea of the right eye. Significant improvement in the integrity of the ocular surface was observed, visual acuity was 20/40+ and the patient was much more comfortable, less symptomatic, and very pleased with her results. Application of the Prokera to the left eye was uneventful, and she returned five days later for removal. The appearance of the ocular surface was notably improved and visual acuity was recorded at 20/30-.

We saw the patient at one week, one month, and most recently a six-month follow up. She has experienced great relief from her discomfort, and once again she can read without the distraction of watering and pain. Upon examination of her corneas, we have observed a significant reduction in fluorescein staining, and a more stable, uniformly dispersed tear film. Her binocular visual acuity is now 20/30.

This is but one example of a growing-number of our patients who have benefited from Prokera. It’s very gratifying to be able to participate in improving the quality of life for our patients. Witnessing the excitement of this woman re-experiencing a return to an activity for which she has great passion, was a great experience for me, and all of our staff. Prokera continues to be a powerful, enduring treatment, and a real difference maker.

Thomas Blue, OD is in private practice in Del City, Oklahoma, as part of Mid-Del Vision Source. His anterior segment treatment background and observations in caring for residents in nursing homes throughout the state, led Dr. Blue to focus on the detection and prevention of the evolution of ocular surface conditions.

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