Cornea guttata is a degenerative disease which causes accumulation of focal outgrowths in form of droplet-shaped bulges, by corneal surface. It is the early stage of Fuchs’ dystrophy.
Patients who are suffering with cornea guttata disease have a huge risk when they want to have corneal transplantation. Cornea guttata is a disease in which the patients have a droplet shaped bulges over the corneal surface inside the eye. There is an accumulation of focal outgrowths which are called as ‘guttae’ in cornea guttata.
This disease is an alternative of a corneal disease which is called as Fuchs’ dystrophy. As it affects the cornea in the eye, it causes loss of vision or impairment of vision.
It causes problems in corneal epithelium, which consists of cells which are used in corneal transplant surgery. In cornea guttata, the membrane gets thickened by the increase in collagen accumulation and number of guttae. The decrease in Endothelial cells causes endothelial edema i.e, inflammation or swelling which causes influx of aqueous humor into cornea. This results in blurred vision or in severe cases loss of vision.
Symptoms of Cornea Guttata
- There is a loss of transparency inside the eye
- Fluctuating and reduced vision
- Thickening of cornea.
- Severe pain
- In severe cases, compromised vision is seen
- No perception of images, during morning
- Loss of acuity
Diagnosis of Cornea Guttata
Since cornea guttata is the initial stage of Fuchs’ dystrophy. Usually, this condition is seen in women commonly. Not only that, a family history is present i.e, the patients have one or more suffering with this disease in a family.
So, an eye examination using a slit lamp helps in identification of cornea guttata condition. As the droplet shaped bulges are seen on the cornea. Usually in the central cornea, the guttata are seen and present in both the eyes. Though, the guttata present in one eye can be more in number and severe than the other eye. The increase in severity in cornea guttata condition leads to development of haze in corneal stroma.
As this stroma state increases, it thickens the stoma and causes visibility of endothelial cells of the cornea and even more cells get damaged.
By use of pachymetry i.e, the measurement of corneal thickness of the eye. As the disease increases, the corneal thickness increases in size. So the measurement of corneal thickness helps in diagnosing the disease. The corneal thickness has it’s own advantage i.e, it also helps in analysis of risk/benefit ratio in other surgeries such as cataract surgery.
The changes in endothelium and mild corneal stromal edema helps in early diagnosis of cornea guttata case. The patients can be guided upon the severity of the corneal guttata condition, by understanding the endothelial changes and their cell count. The endothelial changes can be diagnosed with the help of specular microscopy.
The cornea guttata conditions is usually seen in people who are aged above 40 years and is rarely seen in people who are young i.e, between 30 to 40 years of age. Women are easily affected by this condition.
The person suffering with cornea guttata condition usually tend to pass on their disease through genetic factors i.e, have 50% chances to pass on their gene to their progeny.
Treatment of Cornea Guttata
Use of medicine
It can be removed by the use of eye drops and hypertonic saline or ointments. The hypertonic saline is used for removing the excess water from the bulges present over the cornea. The decrease in water from the cornea helps in reducing cornea guttata and decreases the time taken for recovery of vision. Various activities help in recovery of vision, are usage of hair dryers to provide clear vision by blowing of air. In severe cases, use of bandage contact lenses can be really helpful in treatment. Surgery can be the last option for treatment when the cornea guttata condition becomes more severe i.e, Fuchs’ dystrophy.
Various surgical procedures are used for treating this condition when the medical procedures cannot help in treating cornea guttata. The procedures are
- Penetrating keratoplasty
- Descemet’s stripping endothelial keratoplasty
- Descemet’s membrane endothelial keratoplasty
- Descemetorhexis Without Endothelial Keratoplasty
Complications due to Surgical procedure
The complications which are seen in surgical procedure are infection, bleeding and wound leakages and problems caused due to sutures.
Use of topical steroids for long term can cause other eye related complications such as cataracts and glaucoma inside the eye. Sometimes due to the surgeries, there is a risk of detachment of graft with a need of re-bubbling constantly and repetition in supine positioning and exchange in graft occasionally. There is a loss of vision and severe eye pain due to increase in complications.
The patient is asked to come more often to check up after the few weeks, after the surgery, so that the doctor can check for any kind of problems inside the eye. Evaluation of transplant health, wound healing and recovery of vision is checked through the checkups. Not only have that, evened the removal of sutures reducing astigmatism.
Surgical procedures that include transplantation process have more potency for rejection than the normal organ transplant surgery. At any point of the surgery, the cornea transplant can be rejected by the eye. So, checkup is required for the treatment of any kind of rejection of transplant. Glaucoma can be seen after surgery in some patients as an adverse effect. Glaucoma can cause permanent blindness of the patient.
For some patients who are suffering with the disease and mild guttata condition, and have no corneal stromal edema need to go for checkup for every 6 to 12 months. Patient who is suffering with severe case must be checked more often so that the treatment is adequate. Patients who are using bandage contact lenses have more risk of getting an infection, so they must checked even more.
After phacoemulsification method, the patients who are suffering with cornea guttata have major risk for corneal transplant. Cornea guttata condition causes damage of endothelial cells. So, the patients who are suffering with cornea guttata do not undergo transplant because it increases the loss of cells and increase in Cornea guttata condition even more.
Fuchs’ endothelial corneal dystrophy also known as FECD, is a disease whose initial stage is cornea guttata and it is bilateral degenerative corneal disease which in severe cases causes increase in corneal swelling and endothelial decomposition occurs, this results in impairment of vision. Cornea guttata is just early stage of Fuchs’ dystrophy, but this condition can also be seen in glaucoma, inflammation, traumatic conditions and aging.
The phacoemulsification in patients, who are suffering with cornea guttata is correlated with corneal transplantation. In first year after phacoemulsification, the patients have reduced in number. Increase in age during phacoemulsification causes decrease in probability of patients who are undergoing corneal transplant surgery.
Since, the transplantation deals with much more complex post operative procedure as it lasts for life long. So, the study of patients who are suffering with this condition and want to have corneal transplantation surgery during their initial years of cataract surgery would be really interesting.