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Abstract #117191 Published in IGR 24-4
How Would Nature See Our Corneal Triumphs? The LXXIX Edward Jackson Lecture
Melles GRJ; Parker JS; Parker JSAmerican Journal of Ophthalmology 2024; 263: 11-22
PURPOSE: To describe discrepancies between clinical observation and current teachings in corneal endothelial disease, particularly in Fuchs endothelial dystrophy and its potential association with primary open angle glaucoma. DESIGN: Perspective. METHODS: A perspective is presented on Fuchs dystrophy, a disorder that commonly presents with a compromised endothelium but minimal stromal edema, indicating that the corneal imbibition pressure is relatively "too high." RESULTS: The discrepancy between the relative lack of stromal edema in the absence of an endothelial cell layer cannot be explained by the current theories involving a circulatory pumping mechanism over the endothelial cell layer, but may point to the following: (1) secondary involvement of the corneal endothelium in Fuchs dystrophy; (2) separate hydration systems for maintaining the imbibition pressure (vertical static hydration) and corneal nutrition (horizontal dynamic hydration); (3) the cornea as net contributor of aqueous humor; (4) a close relationship between the corneal imbibition and intraocular pressure, with potentially a shared regulatory system; and (5) a potential steroid-type hormone dependency of this regulatory system. CONCLUSIONS: Clinical observation shows that the stromal imbibition pressure is "too high" in Fuchs endothelial dystrophy, indicating that it may not primarily be an endothelial disease, but a type of "corneal glaucoma."
From the Netherlands Institute for Innovative Ocular Surgery (G.R.J.M.), Rotterdam, the Netherlands; Melles Cornea Clinic (G.R.J.M.), Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam (G.R.J.M.), the Netherlands; NIIOS-USA (G.R.J.M., J.S.P.) San Diego, California, USA. Electronic address: research@niios.com.
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