Summer 2012 Newsletter - The Corneal Dystrophy Foundation

Education…
Research Corner
Dr. Natalie Afshari, MD, MA
Professor of Ophthalmology and Cornea
Fellowship Program Director in the Department of
Ophthalmology at Duke Eye Center, Duke
University School of Medicine, Durham, NC
Fuchs endothelial corneal
dystrophy leads to
decreased visual acuity as a
result of inappropriate loss
of corneal endothelial cells,
thickening of the cornea,
and guttata formation.
Corneal endothelial cells
which make the innermost
cell layer of the cornea are
pump cells that pump fluid out of the cornea.
Significant reduction in endothelial cell density
results in insufficient pump function required for
the cornea to remain clear and dehydrated. As a
result, the cornea becomes edematous, corneal
transparency is compromised, and vision decreases
if left untreated.
Currently, cornea transplantation remains the only
effective treatment option for individuals with
FECD, but the procedure itself is not without
associated risks that could be avoided with the
development of a pharmacologic alternative to
surgery.
Dr. Natalie Afshari, Professor of Ophthalmology,
and colleagues have been researching the
therapeutic potential of agents known as ROCK
inhibitors, in effort to treat patients with FECD
more effectively, and with topical medications
versus surgical intervention. To date, results have
been promising. Application of ROCK inhibitor to
corneal endothelial cells in vitro has led to
significantly enhanced endothelial cell proliferation
and endothelial cell migration, a finding that could
contribute to restoration of corneal clarity and
visual acuity otherwise lost in Fuchs corneal
dystrophy. Furthermore, topical administration of
ROCK inhibitors in animals has demonstrated a
marked reduction of corneal edema and
accelerated corneal thinning in treated eyes.
Collectively, these preliminary studies may
demonstrate the efficacy of ROCK inhibitors as
potential topical therapy for patients with FECD
and other forms of corneal endothelial disease.
Further research is ongoing.
Also, Dr. Natalie Afshari and colleagues have
investigated the effect of corneal transplantation
on corneal biomechanics in subjects with Fuchs
corneal dystrophy who underwent DSEK. Eyes with
Fuchs corneal dystrophy that underwent DSEK did
not have dramatic changes in cornea resistance
factor or corneal hysteresis (markers of corneal
biomechanics) when compared to controls. This is
understandable as in DSEK only a thin layer of
cornea is replaced.