Guttae are tiny bumps on the cornea of the eye that indicate Fuchs corneal endothelial dystrophy, a genetic eye disease that causes vision loss. Symptoms include blurred vision, discomfort in bright lights, and poor night vision. There are two surgical treatments available.
Guttae is the plural form of the word gutta, from a Latin word meaning “drops”. They are tiny bumps that form and face inward on the endothelium layer at the back of the cornea of the eye. These small bumps are an indication of a genetic eye disease known as Fuchs corneal endothelial dystrophy (FECD). The disease comes in two forms: early onset from a mutation on chromosome 8A and late onset from mutations on chromosomes 13 and 18. When the guttas build up, they cause loss of vision and swelling of the cornea.
The cornea is the clear tissue in front of the eye. The endothelium is a translucent hexagonal cell layer of bundled collagen fibers within the cornea in front of the lens, stroma, and retina. The guttas cause the endothelial cells to become thinner than normal, particularly in the upper part of the guttas as they rise and spread.
Symptoms are usually noticed after several guttae have formed, when the eyes feel coarse or rough and vision blurs as fluids begin to collect in the cornea and stroma, which are normally in a dry state. Bright lights can cause discomfort or pain in people with the condition, and vision usually fluctuates throughout the day and from day to day. Most patients report poor night vision and blurry vision with poor color contrast, as if grease had been smeared on the lenses of the eyeglasses.
Another feature of corneal dystrophy is a thickening of Descemet’s membrane, which lines the endothelium and faces the lens and retina. Guttas will continue to form along this membrane. There are five stages of Fuchs’ dystrophy and it usually takes 10 to 20 years to progress from one stage to the next. As more and more guttae form and spread, the stages become a measure of how much of the eye’s surface is affected and the level of vision distortion.
There are two surgical treatments for FECD. In an outpatient surgery called penetrating keratoplasty, the cornea is removed and replaced with a donor cornea that is sutured in place. Another possible surgery is called Descemet stripping with endothelial keratoplasty. This surgical procedure replaces only the back half of the endothelial layers and Descemet’s membrane behind the cornea with parts from a donor.
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