Emerging Innovations in the Treatment of Fuchs Endothelial Corneal Dystrophy: A Narrative Review

Niestrata, Magdalena; Jackson, James; Bazeer, Shehnaz; Gong, Mingya Alexa; Ashena, Zahra

doi:10.3390/medsci13040238

Open AccessEditor’s ChoiceReview

Emerging Innovations in the Treatment of Fuchs Endothelial Corneal Dystrophy: A Narrative Review

by

Magdalena Niestrata

^1,*

,

James Jackson

²,

Shehnaz Bazeer

³,

Mingya Alexa Gong

¹ and

Zahra Ashena

⁴

¹

Department of Ophthalmology, Institute of Ophthalmology, University College London (UCL), London WC1E 6BT, UK

²

Data Governance and Statutory Returns, University of East London (UEL), London E16 2RD, UK

³

Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK

⁴

Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, London RM1 2BA, UK

^*

Author to whom correspondence should be addressed.

Med. Sci. 2025, 13(4), 238; https://doi.org/10.3390/medsci13040238

Submission received: 25 June 2025 / Revised: 23 August 2025 / Accepted: 28 August 2025 / Published: 22 October 2025

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Abstract

Fuchs endothelial corneal dystrophy (FECD) is the leading cause of endothelial failure requiring keratoplasty in industrialised nations. Descemet membrane endothelial keratoplasty (DMEK) has become the gold-standard surgical therapy, yet it is constrained by limited donor tissue and a steep learning curve. This narrative review summarises current and emerging therapeutic strategies for FECD. We describe conventional endothelial keratoplasty and its outcomes, tissue-sparing procedures such as descemetorhexis without endothelial keratoplasty (DWEK) and quarter-DMEK, regenerative approaches including cultured endothelial cell injection and synthetic corneal substitutes, and adjunctive innovations ranging from Rho-associated kinase inhibitors to artificial intelligence-assisted diagnostics. Challenges surrounding donor shortages, variable clinical outcomes, regulatory hurdles and cost are critically appraised. We conclude by outlining future directions that are likely to combine advanced surgical techniques with cell-based and biomaterial solutions to deliver accessible, long-term restoration of vision for patients with FECD.

Keywords: Fuchs endothelial corneal dystrophy; DMEK; DWEK; endothelial cell therapy; synthetic cornea; ROCK inhibitor; artificial intelligence; review

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MDPI and ACS Style

Niestrata, M.; Jackson, J.; Bazeer, S.; Gong, M.A.; Ashena, Z. Emerging Innovations in the Treatment of Fuchs Endothelial Corneal Dystrophy: A Narrative Review. Med. Sci. 2025, 13, 238. https://doi.org/10.3390/medsci13040238

AMA Style

Niestrata M, Jackson J, Bazeer S, Gong MA, Ashena Z. Emerging Innovations in the Treatment of Fuchs Endothelial Corneal Dystrophy: A Narrative Review. Medical Sciences. 2025; 13(4):238. https://doi.org/10.3390/medsci13040238

Chicago/Turabian Style

Niestrata, Magdalena, James Jackson, Shehnaz Bazeer, Mingya Alexa Gong, and Zahra Ashena. 2025. "Emerging Innovations in the Treatment of Fuchs Endothelial Corneal Dystrophy: A Narrative Review" Medical Sciences 13, no. 4: 238. https://doi.org/10.3390/medsci13040238

APA Style

Niestrata, M., Jackson, J., Bazeer, S., Gong, M. A., & Ashena, Z. (2025). Emerging Innovations in the Treatment of Fuchs Endothelial Corneal Dystrophy: A Narrative Review. Medical Sciences, 13(4), 238. https://doi.org/10.3390/medsci13040238

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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Emerging Innovations in the Treatment of Fuchs Endothelial Corneal Dystrophy: A Narrative Review

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