Cornea guttata

Regarding OVD application with intraoperative complications, tissue stability and movement must be differentiated from selective tissue isolation (Fig. 53). Healon 5, Healon GV, Microvisc (Plus), Morcher Oil (Plus), Viscorneal (Plus) (identical to Allervisc (Plus) in content), and other viscoelastic substances are considered suitable to counter a flattened anterior chamber, widen a small pupil, simplify a complicated capsulorhexis, resolve synechiae, or counter iridal and vitreous prolapse (Fig. 54). Endothelial dystrophy (Fuchs Dystrophy, advanced cornea guttata), torn posterior capsule or vitreous prolapse are particularly well suited for Viscoat application (followed by AMO Vitrax , HPMC Ophta H, Visco Shield , and other HPMC products). These viscoelastics are preferred substances in case of zonular dialysis with vitreous body prolapse or sinking nucleus (Fig. 55). 

Fuchs (endothelial) dystrophy has a component of guttata, but the involvement is such that corneal physiology is affected adversely. Fuchs dystrophy occurs bilaterally, has been reported to be transmitted dominantly (with incomplete penetrance), and females are three times more likely to develop the condition. Prominent guttata initially occur centrally and then become extensive enough to involve the peripheral cornea. In Fuchs dystrophy the... 

Figure 26-5 649 Specular reflection illumination reveals the honeycomb appearance of the normal cornea and the black zones in the endothelium caused by guttata arrow). (B) TransiUumination revealing orange-peel dimpling characteristic of central corneal guttata arrow). (Courtesy of Pat Caroline.)...

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