Descemet Endothelial Thickness Comparison Trial I

Open to people ages 18 years and up

• Dysfunctional endothelium from Fuchs Endothelial Corneal Dystrophy (FECD) with guttata extending beyond 4.5 mm of the central cornea
• Dysfunctional endothelium from Pseudophakic Corneal Edema (PCE) or Iridocorneal Endothelial Syndrome (ICE) or other primary endothelial dysfunction such as Posterior Polymorphous Corneal Dystrophy (PPMD)
• Controlled uveitis (defined as quiet for > 3 months off of topical steroids with or without systemic immunosuppression)
• Controlled glaucoma with topical medications and/or prior trabeculectomy or tube shunt without ongoing hypotony (IOP < 5 mmHg)
• Good candidate for corneal transplantation for either DMEK or UT-DSAEK
• Prior graft failure after PKP or EK
• Willingness and ability to undergo corneal transplantation
• Willingness to consistently use study medications (i.e. ROCK-inhibitors)
• Willingness to participate in follow-up visits
• Age greater than 18 years

• Uncontrolled uveitis
• Aphakia, or anterior chamber IOL in study eye prior to or anticipated during EK
• Pre-operative central sub-epithelial or stromal scarring that the investigator believes is visually significant and could impact post-operative stromal clarity assessment
• Peripheral anterior synechiae (iris to angle) in the angle greater than a total of three clock hours
• Uncontrolled glaucoma (IOP >25 mmHg)
• Visually significant optic nerve (ok to have small visual field defects) or macular severe pathology
• Participants who are not suitable for the DMEK or UT-DSAEK surgeries
• Indication for surgery that is not suitable for EK (e.g. keratoconus, stromal dystrophies and scars)
• Planned intraocular lens exchange of an anterior chamber IOL with a posterior chamber IOL at time of study EK
• Hypotony (Intraocular pressure <10mmHg)
• Inability to comply with post-operative instructions (i.e. unable to position)
• Participants who are decisionally and/or cognitively impaired
• Pregnancy
• Fellow eye visual acuity <20/200
• Children (18 years and under)