Skip to main content
Top
Published in: International Ophthalmology 1/2024

01-12-2024 | Keratoplasty | Review

Fuchs endothelial corneal dystrophy: an updated review

Authors: Francisco Altamirano, Gustavo Ortiz-Morales, Mario A. O’Connor-Cordova, Juan Pablo Sancén-Herrera, Judith Zavala, Jorge E. Valdez-Garcia

Published in: International Ophthalmology | Issue 1/2024

Login to get access

Abstract

Purpose

The present review will summarize FECD-associated genes and pathophysiology, diagnosis, current  therapeutic approaches, and future treatment perspectives.

Methods

Literature review.

Results

Fuchs' endothelial corneal dystrophy (FECD) is the most common bilateral corneal dystrophy and accounts for one-third of all corneal transplants performed in the US. FECD is caused by a combination of genetic and non-heritable factors, and there are two types: early-onset FECD, which affects individuals from an early age and is usually more severe, and late-onset FECD, which is more common and typically manifests around the age of 40. The hallmark findings of FECD include progressive loss of corneal endothelial cells and the formation of focal excrescences (guttae) on the Descemet membrane. These pathophysiological changes result in progressive endothelial dysfunction, leading to a decrease in visual acuity and blindness in later stages. The present review will summarize FECD-associated genes and pathophysiology, diagnosis, current therapeutic approaches, and future treatment perspectives.

Conclusion

With the characterization and understanding of FECD-related genes and ongoing research into regenerative therapies for corneal endothelium, we can hope to see more significant improvements in the future in the management and care of the disease.
Literature
1.
go back to reference Fuchs E (1910) Dystrophia epithelialis corneae. Albrecht von Graefes Archiv für Ophthalmologie 76(3):478–508CrossRef Fuchs E (1910) Dystrophia epithelialis corneae. Albrecht von Graefes Archiv für Ophthalmologie 76(3):478–508CrossRef
2.
go back to reference Sarnicola C, Farooq AV, Colby K (2019) Fuchs endothelial corneal dystrophy: update on pathogenesis and future directions. Eye Contact Lens 45(1):1–10PubMedCrossRef Sarnicola C, Farooq AV, Colby K (2019) Fuchs endothelial corneal dystrophy: update on pathogenesis and future directions. Eye Contact Lens 45(1):1–10PubMedCrossRef
4.
go back to reference Oie Y, Watanabe S, Nishida K (2016) Evaluation of visual quality in patients with Fuchs endothelial corneal dystrophy. Cornea 35(Suppl 1):S55–S58PubMedCrossRef Oie Y, Watanabe S, Nishida K (2016) Evaluation of visual quality in patients with Fuchs endothelial corneal dystrophy. Cornea 35(Suppl 1):S55–S58PubMedCrossRef
5.
go back to reference Vedana G, Villarreal G Jr, Jun AS (2016) Fuchs endothelial corneal dystrophy: current perspectives. Clin Ophthalmol 10:321–330PubMedPubMedCentral Vedana G, Villarreal G Jr, Jun AS (2016) Fuchs endothelial corneal dystrophy: current perspectives. Clin Ophthalmol 10:321–330PubMedPubMedCentral
6.
go back to reference Zhang J, McGhee CNJ, Patel DV (2019) The molecular basis of Fuchs’ endothelial corneal dystrophy. Mol Diagn Ther 23(1):97–112PubMedCrossRef Zhang J, McGhee CNJ, Patel DV (2019) The molecular basis of Fuchs’ endothelial corneal dystrophy. Mol Diagn Ther 23(1):97–112PubMedCrossRef
7.
go back to reference Valdez J, Ortiz Morales G, Morales-Mancillas N, Loya-García D, Nava-García JA, Hernández-Camarena J (2022) Visual outcome after trifocal intraocular lens exchange in a patient with cornea Guttata. Revista Mexicana de Oftalmología (English Edition) 96:131–134 Valdez J, Ortiz Morales G, Morales-Mancillas N, Loya-García D, Nava-García JA, Hernández-Camarena J (2022) Visual outcome after trifocal intraocular lens exchange in a patient with cornea Guttata. Revista Mexicana de Oftalmología (English Edition) 96:131–134
8.
go back to reference Higa A, Sakai H, Sawaguchi S, Iwase A, Tomidokoro A, Amano S et al (2011) Prevalence of and risk factors for cornea guttata in a population-based study in a southwestern island of Japan: the Kumejima study. Arch Ophthalmol 129(3):332–336PubMedCrossRef Higa A, Sakai H, Sawaguchi S, Iwase A, Tomidokoro A, Amano S et al (2011) Prevalence of and risk factors for cornea guttata in a population-based study in a southwestern island of Japan: the Kumejima study. Arch Ophthalmol 129(3):332–336PubMedCrossRef
9.
go back to reference Matthaei M, Hribek A, Clahsen T, Bachmann B, Cursiefen C, Jun AS (2019) Fuchs endothelial corneal dystrophy: clinical, genetic, pathophysiologic, and therapeutic aspects. Annu Rev Vis Sci 5:151–175PubMedCrossRef Matthaei M, Hribek A, Clahsen T, Bachmann B, Cursiefen C, Jun AS (2019) Fuchs endothelial corneal dystrophy: clinical, genetic, pathophysiologic, and therapeutic aspects. Annu Rev Vis Sci 5:151–175PubMedCrossRef
10.
go back to reference Zhu AY, Jaskula-Ranga V, Jun AS (2018) Gene editing as a potential therapeutic solution for fuchs endothelial corneal dystrophy: the future is clearer. JAMA Ophthalmol 136(9):969–970PubMedCrossRef Zhu AY, Jaskula-Ranga V, Jun AS (2018) Gene editing as a potential therapeutic solution for fuchs endothelial corneal dystrophy: the future is clearer. JAMA Ophthalmol 136(9):969–970PubMedCrossRef
11.
go back to reference Nanda GG, Alone DP (2019) REVIEW: current understanding of the pathogenesis of Fuchs’ endothelial corneal dystrophy. Mol Vis 25:295–310PubMedPubMedCentral Nanda GG, Alone DP (2019) REVIEW: current understanding of the pathogenesis of Fuchs’ endothelial corneal dystrophy. Mol Vis 25:295–310PubMedPubMedCentral
12.
go back to reference Soh YQ, Peh GS, Mehta JS (2018) Evolving therapies for Fuchs’ endothelial dystrophy. Regen Med 13(1):97–115PubMedCrossRef Soh YQ, Peh GS, Mehta JS (2018) Evolving therapies for Fuchs’ endothelial dystrophy. Regen Med 13(1):97–115PubMedCrossRef
13.
go back to reference Eghrari AO, McGlumphy EJ, Iliff BW, Wang J, Emmert D, Riazuddin SA et al (2012) Prevalence and severity of fuchs corneal dystrophy in Tangier Island. Am J Ophthalmol 153(6):1067–1072PubMedPubMedCentralCrossRef Eghrari AO, McGlumphy EJ, Iliff BW, Wang J, Emmert D, Riazuddin SA et al (2012) Prevalence and severity of fuchs corneal dystrophy in Tangier Island. Am J Ophthalmol 153(6):1067–1072PubMedPubMedCentralCrossRef
15.
go back to reference Cui Z, Zeng Q, Guo Y, Liu S, Wang P, Xie M et al (2018) Pathological molecular mechanism of symptomatic late-onset Fuchs endothelial corneal dystrophy by bioinformatic analysis. PLoS ONE 13(5):e0197750PubMedPubMedCentralCrossRef Cui Z, Zeng Q, Guo Y, Liu S, Wang P, Xie M et al (2018) Pathological molecular mechanism of symptomatic late-onset Fuchs endothelial corneal dystrophy by bioinformatic analysis. PLoS ONE 13(5):e0197750PubMedPubMedCentralCrossRef
16.
go back to reference Ortiz Morales G, Quiroga-Garza ME, Bastán-Fabián D, Salinas-Lugo MA, Nava-Garcia JA, Loya-Garcia D et al (2022) Endothelial morphometric characteristics in primary cornea Guttata. Investig Ophthalmol Visual Sci 63(7):2764-A0253 Ortiz Morales G, Quiroga-Garza ME, Bastán-Fabián D, Salinas-Lugo MA, Nava-Garcia JA, Loya-Garcia D et al (2022) Endothelial morphometric characteristics in primary cornea Guttata. Investig Ophthalmol Visual Sci 63(7):2764-A0253
17.
go back to reference Barrera-Sanchez M, Hernandez-Camarena JC, Ruiz-Lozano RE, Valdez-Garcia JE, Rodriguez-Garcia A (2022) Demographic profile and clinical course of Fuchs endothelial corneal dystrophy in Mexican patients. Int Ophthalmol 42(4):1299–1309PubMedCrossRef Barrera-Sanchez M, Hernandez-Camarena JC, Ruiz-Lozano RE, Valdez-Garcia JE, Rodriguez-Garcia A (2022) Demographic profile and clinical course of Fuchs endothelial corneal dystrophy in Mexican patients. Int Ophthalmol 42(4):1299–1309PubMedCrossRef
19.
go back to reference Eghrari AO, Riazuddin SA, Gottsch JD (2015) Overview of the cornea: structure, function, and development. Prog Mol Biol Transl Sci 134:7–23PubMedCrossRef Eghrari AO, Riazuddin SA, Gottsch JD (2015) Overview of the cornea: structure, function, and development. Prog Mol Biol Transl Sci 134:7–23PubMedCrossRef
20.
go back to reference DelMonte DW, Kim T (2011) Anatomy and physiology of the cornea. J Cataract Refract Surg 37(3):588–598PubMedCrossRef DelMonte DW, Kim T (2011) Anatomy and physiology of the cornea. J Cataract Refract Surg 37(3):588–598PubMedCrossRef
21.
go back to reference Zhang J, Patel DV (2015) The pathophysiology of Fuchs’ endothelial dystrophy–a review of molecular and cellular insights. Exp Eye Res 130:97–105PubMedCrossRef Zhang J, Patel DV (2015) The pathophysiology of Fuchs’ endothelial dystrophy–a review of molecular and cellular insights. Exp Eye Res 130:97–105PubMedCrossRef
22.
go back to reference Liu X, Zheng T, Zhao C, Zhang Y, Liu H, Wang L et al (2021) Genetic mutations and molecular mechanisms of Fuchs endothelial corneal dystrophy. Eye and Vision 8(1):24PubMedPubMedCentralCrossRef Liu X, Zheng T, Zhao C, Zhang Y, Liu H, Wang L et al (2021) Genetic mutations and molecular mechanisms of Fuchs endothelial corneal dystrophy. Eye and Vision 8(1):24PubMedPubMedCentralCrossRef
23.
go back to reference Fautsch MP, Wieben ED, Baratz KH, Bhattacharyya N, Sadan AN, Hafford-Tear NJ et al (2021) TCF4-mediated Fuchs endothelial corneal dystrophy: Insights into a common trinucleotide repeat-associated disease. Prog Retin Eye Res 81:100883PubMedPubMedCentralCrossRef Fautsch MP, Wieben ED, Baratz KH, Bhattacharyya N, Sadan AN, Hafford-Tear NJ et al (2021) TCF4-mediated Fuchs endothelial corneal dystrophy: Insights into a common trinucleotide repeat-associated disease. Prog Retin Eye Res 81:100883PubMedPubMedCentralCrossRef
24.
go back to reference Jalimarada SS, Ogando DG, Bonanno JA (2014) Loss of ion transporters and increased unfolded protein response in Fuchs’ dystrophy. Mol Vis 20:1668–1679PubMedPubMedCentral Jalimarada SS, Ogando DG, Bonanno JA (2014) Loss of ion transporters and increased unfolded protein response in Fuchs’ dystrophy. Mol Vis 20:1668–1679PubMedPubMedCentral
25.
go back to reference Jurkunas UV (2018) Fuchs endothelial corneal dystrophy through the prism of oxidative stress. Cornea 37(Suppl 1):S50–S54PubMedCrossRef Jurkunas UV (2018) Fuchs endothelial corneal dystrophy through the prism of oxidative stress. Cornea 37(Suppl 1):S50–S54PubMedCrossRef
27.
go back to reference Wieben ED, Aleff RA, Tosakulwong N, Butz ML, Highsmith WE, Edwards AO et al (2012) A common trinucleotide repeat expansion within the transcription factor 4 (TCF4, E2–2) gene predicts Fuchs corneal dystrophy. PLoS ONE 7(11):e49083PubMedPubMedCentralCrossRefADS Wieben ED, Aleff RA, Tosakulwong N, Butz ML, Highsmith WE, Edwards AO et al (2012) A common trinucleotide repeat expansion within the transcription factor 4 (TCF4, E2–2) gene predicts Fuchs corneal dystrophy. PLoS ONE 7(11):e49083PubMedPubMedCentralCrossRefADS
28.
29.
go back to reference Malhotra D, Loganathan SK, Chiu AM, Lukowski CM, Casey JR (2019) Human corneal expression of SLC4A11, a gene mutated in endothelial corneal dystrophies. Sci Rep 9(1):9681PubMedPubMedCentralCrossRefADS Malhotra D, Loganathan SK, Chiu AM, Lukowski CM, Casey JR (2019) Human corneal expression of SLC4A11, a gene mutated in endothelial corneal dystrophies. Sci Rep 9(1):9681PubMedPubMedCentralCrossRefADS
30.
go back to reference Jurkunas UV, Bitar MS, Funaki T, Azizi B (2010) Evidence of oxidative stress in the pathogenesis of fuchs endothelial corneal dystrophy. Am J Pathol 177(5):2278–2289PubMedPubMedCentralCrossRef Jurkunas UV, Bitar MS, Funaki T, Azizi B (2010) Evidence of oxidative stress in the pathogenesis of fuchs endothelial corneal dystrophy. Am J Pathol 177(5):2278–2289PubMedPubMedCentralCrossRef
31.
go back to reference Jurkunas UV, Rawe I, Bitar MS, Zhu C, Harris DL, Colby K et al (2008) Decreased expression of peroxiredoxins in Fuchs’ endothelial dystrophy. Invest Ophthalmol Vis Sci 49(7):2956–2963PubMedCrossRef Jurkunas UV, Rawe I, Bitar MS, Zhu C, Harris DL, Colby K et al (2008) Decreased expression of peroxiredoxins in Fuchs’ endothelial dystrophy. Invest Ophthalmol Vis Sci 49(7):2956–2963PubMedCrossRef
32.
33.
go back to reference Methot SJ, Proulx S, Brunette I, Rochette PJ (2020) Chronology of cellular events related to mitochondrial burnout leading to cell death in Fuchs endothelial corneal dystrophy. Sci Rep 10(1):5811PubMedPubMedCentralCrossRefADS Methot SJ, Proulx S, Brunette I, Rochette PJ (2020) Chronology of cellular events related to mitochondrial burnout leading to cell death in Fuchs endothelial corneal dystrophy. Sci Rep 10(1):5811PubMedPubMedCentralCrossRefADS
34.
go back to reference Fritz M, Grewing V, Maier P, Lapp T, Bohringer D, Reinhard T et al (2019) Diurnal variation in corneal edema in Fuchs endothelial corneal dystrophy. Am J Ophthalmol 207:351–355PubMedCrossRef Fritz M, Grewing V, Maier P, Lapp T, Bohringer D, Reinhard T et al (2019) Diurnal variation in corneal edema in Fuchs endothelial corneal dystrophy. Am J Ophthalmol 207:351–355PubMedCrossRef
35.
go back to reference Valdez J, Zavala J, Ruiz-Lozano R, Padilla-Alanis S, Jiménez J (2022) Gestión del Riesgo de Daño Endotelial Corneal Asociado a la Cirugía de Catarata. Highlights Ophthalmol 50:22–32CrossRef Valdez J, Zavala J, Ruiz-Lozano R, Padilla-Alanis S, Jiménez J (2022) Gestión del Riesgo de Daño Endotelial Corneal Asociado a la Cirugía de Catarata. Highlights Ophthalmol 50:22–32CrossRef
36.
go back to reference Patel SV (2019) Towards clinical trials in fuchs endothelial corneal dystrophy: classification and outcome measures-the bowman club lecture 2019. BMJ Open Ophthalmol 4(1):e000321PubMedPubMedCentralCrossRef Patel SV (2019) Towards clinical trials in fuchs endothelial corneal dystrophy: classification and outcome measures-the bowman club lecture 2019. BMJ Open Ophthalmol 4(1):e000321PubMedPubMedCentralCrossRef
37.
go back to reference Huang MJ, Kane S, Dhaliwal DK (2018) Descemetorhexis without endothelial keratoplasty versus DMEK for treatment of fuchs endothelial corneal dystrophy. Cornea 37(12):1479–1483PubMedCrossRef Huang MJ, Kane S, Dhaliwal DK (2018) Descemetorhexis without endothelial keratoplasty versus DMEK for treatment of fuchs endothelial corneal dystrophy. Cornea 37(12):1479–1483PubMedCrossRef
38.
go back to reference Stulting RD, Lass JH, Terry MA, Benetz BA, Cohen NJ, Ayala AR et al (2018) Factors associated with graft rejection in the cornea preservation time study. Am J Ophthalmol 196:197–207PubMedPubMedCentralCrossRef Stulting RD, Lass JH, Terry MA, Benetz BA, Cohen NJ, Ayala AR et al (2018) Factors associated with graft rejection in the cornea preservation time study. Am J Ophthalmol 196:197–207PubMedPubMedCentralCrossRef
39.
go back to reference Singh P, Sinha A, Nagpal R, Chaurasia S (2022) Descemet membrane endothelial keratoplasty: update on preoperative considerations, surgical techniques, and outcomes. Indian J Ophthalmol 70(9):3222–3238PubMedPubMedCentralCrossRef Singh P, Sinha A, Nagpal R, Chaurasia S (2022) Descemet membrane endothelial keratoplasty: update on preoperative considerations, surgical techniques, and outcomes. Indian J Ophthalmol 70(9):3222–3238PubMedPubMedCentralCrossRef
40.
go back to reference Kemer OE, Karaca EE, Oellerich S, Melles G (2021) Evolving techniques and indications of descemet membrane endothelial keratoplasty. Turk J Ophthalmol 51(6):381–392PubMedPubMedCentralCrossRef Kemer OE, Karaca EE, Oellerich S, Melles G (2021) Evolving techniques and indications of descemet membrane endothelial keratoplasty. Turk J Ophthalmol 51(6):381–392PubMedPubMedCentralCrossRef
41.
go back to reference Deng SX, Lee WB, Hammersmith KM, Kuo AN, Li JY, Shen JF et al (2018) Descemet membrane endothelial keratoplasty: safety and outcomes: a report by the American academy of ophthalmology. Ophthalmology 125(2):295–310PubMedCrossRef Deng SX, Lee WB, Hammersmith KM, Kuo AN, Li JY, Shen JF et al (2018) Descemet membrane endothelial keratoplasty: safety and outcomes: a report by the American academy of ophthalmology. Ophthalmology 125(2):295–310PubMedCrossRef
42.
go back to reference Marques RE, Guerra PS, Sousa DC, Goncalves AI, Quintas AM, Rodrigues W (2019) DMEK versus DSAEK for Fuchs’ endothelial dystrophy: a meta-analysis. Eur J Ophthalmol 29(1):15–22PubMedCrossRef Marques RE, Guerra PS, Sousa DC, Goncalves AI, Quintas AM, Rodrigues W (2019) DMEK versus DSAEK for Fuchs’ endothelial dystrophy: a meta-analysis. Eur J Ophthalmol 29(1):15–22PubMedCrossRef
43.
go back to reference Moshirfar M, Ding Y, Shah TJ (2018) A historical perspective on treatment of Fuchs’ endothelial dystrophy: we have come a long way. J Ophthalmic Vis Res 13(3):339–343PubMedPubMedCentralCrossRef Moshirfar M, Ding Y, Shah TJ (2018) A historical perspective on treatment of Fuchs’ endothelial dystrophy: we have come a long way. J Ophthalmic Vis Res 13(3):339–343PubMedPubMedCentralCrossRef
44.
go back to reference Kinoshita S, Koizumi N, Ueno M, Okumura N, Imai K, Tanaka H et al (2018) Injection of cultured cells with a ROCK inhibitor for bullous keratopathy. N Engl J Med 378(11):995–1003PubMedCrossRef Kinoshita S, Koizumi N, Ueno M, Okumura N, Imai K, Tanaka H et al (2018) Injection of cultured cells with a ROCK inhibitor for bullous keratopathy. N Engl J Med 378(11):995–1003PubMedCrossRef
45.
go back to reference Macsai MS, Shiloach M (2019) Use of topical rho kinase inhibitors in the treatment of Fuchs dystrophy after descemet stripping only. Cornea 38(5):529–534PubMedCrossRef Macsai MS, Shiloach M (2019) Use of topical rho kinase inhibitors in the treatment of Fuchs dystrophy after descemet stripping only. Cornea 38(5):529–534PubMedCrossRef
46.
go back to reference Moloney G, Petsoglou C, Ball M, Kerdraon Y, Hollhumer R, Spiteri N et al (2017) Descemetorhexis without grafting for Fuchs endothelial dystrophy-supplementation with topical Ripasudil. Cornea 36(6):642–648PubMedCrossRef Moloney G, Petsoglou C, Ball M, Kerdraon Y, Hollhumer R, Spiteri N et al (2017) Descemetorhexis without grafting for Fuchs endothelial dystrophy-supplementation with topical Ripasudil. Cornea 36(6):642–648PubMedCrossRef
47.
go back to reference Chatfield KC, Sparagna GC, Chau S, Phillips EK, Ambardekar AV, Aftab M et al (2019) Elamipretide improves mitochondrial function in the failing human heart. JACC Basic Transl Sci 4(2):147–157PubMedPubMedCentralCrossRef Chatfield KC, Sparagna GC, Chau S, Phillips EK, Ambardekar AV, Aftab M et al (2019) Elamipretide improves mitochondrial function in the failing human heart. JACC Basic Transl Sci 4(2):147–157PubMedPubMedCentralCrossRef
48.
go back to reference Dubchak E, Obasanmi G, Zeglinski MR, Granville DJ, Yeung SN, Matsubara JA (2022) Potential role of extracellular granzyme B in wet age-related macular degeneration and fuchs endothelial corneal dystrophy. Front Pharmacol 13:980742PubMedPubMedCentralCrossRef Dubchak E, Obasanmi G, Zeglinski MR, Granville DJ, Yeung SN, Matsubara JA (2022) Potential role of extracellular granzyme B in wet age-related macular degeneration and fuchs endothelial corneal dystrophy. Front Pharmacol 13:980742PubMedPubMedCentralCrossRef
49.
go back to reference Zavala J, López Jaime GR, Rodríguez Barrientos CA, Valdez-Garcia J (2013) Corneal endothelium: developmental strategies for regeneration. Eye 27(5):579–588PubMedPubMedCentralCrossRef Zavala J, López Jaime GR, Rodríguez Barrientos CA, Valdez-Garcia J (2013) Corneal endothelium: developmental strategies for regeneration. Eye 27(5):579–588PubMedPubMedCentralCrossRef
50.
go back to reference Rocha-de-Lossada C, Rachwani-Anil R, Borroni D, Sanchez-Gonzalez JM, Esteves-Marques R, Soler-Ferrandez FL et al (2021) New horizons in the treatment of corneal endothelial dysfunction. J Ophthalmol 2021:6644114PubMedPubMedCentralCrossRef Rocha-de-Lossada C, Rachwani-Anil R, Borroni D, Sanchez-Gonzalez JM, Esteves-Marques R, Soler-Ferrandez FL et al (2021) New horizons in the treatment of corneal endothelial dysfunction. J Ophthalmol 2021:6644114PubMedPubMedCentralCrossRef
51.
go back to reference Valdez J, Mendoza G, Zavala J, Angel Z, Gabriela B, Cortes-Ramirez J et al (2015) In vivo biocompatibility of chitosan and collagen-vitrigel membranes for corneal scaffolding: a comparative analysis. Curr Tissue Eng 5(2):123–129 Valdez J, Mendoza G, Zavala J, Angel Z, Gabriela B, Cortes-Ramirez J et al (2015) In vivo biocompatibility of chitosan and collagen-vitrigel membranes for corneal scaffolding: a comparative analysis. Curr Tissue Eng 5(2):123–129
Metadata
Title
Fuchs endothelial corneal dystrophy: an updated review
Authors
Francisco Altamirano
Gustavo Ortiz-Morales
Mario A. O’Connor-Cordova
Juan Pablo Sancén-Herrera
Judith Zavala
Jorge E. Valdez-Garcia
Publication date
01-12-2024
Publisher
Springer Netherlands
Keyword
Keratoplasty
Published in
International Ophthalmology / Issue 1/2024
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-024-02994-1

Other articles of this Issue 1/2024

International Ophthalmology 1/2024 Go to the issue