Glanatec(R) for Descemet Stripping in Fuch's Endothelial Dystrophy

Inclusion Criteria: * • Ability to understand read and sign the informed consent form. * Age between 30 and \<91 years * Ability to understand and follow instructions and study procedures * Willingness to comply with all study procedures and be available for the duration of the study * Ability to apply eye drop medication and willing to adhere to study medication regimen * Diagnosed with Fuchs dystrophy (clinically and on confocal microscopy) by the study investigator. * Pseudophakic FED with posterior capsule supported, suture-fixated, or sulcus-supported posterior chamber intraocular lens. * Fuchs dystrophy grades 2-4 on the Krachmer grading scale * Presence of central guttae deemed by the investigator to be the chief cause of visual symptoms, rather than cataract or corneal stromal edema * Clear peripheral cornea with an endothelial cell count \>1000 cells/mm2 on specular microscopy * Best corrected visual acuity in the study eye is 20/40 or worse at study enrollment * The patient is dissatisfied with current vision * The patient is otherwise to be offered a corneal graft * For females with reproductive potential, willingness to use highly effective contraception (e.g., hormonal contraception, barrier contraception, intrauterine device, or abstinence). * Indication for surgery may include cataract extraction and posterior chamber intraocular lens implantation Exclusion Criteria: * • Uncontrolled glaucoma (IOP \>25 mmHg) * Presence of secondary corneal pathology such as infective or autoimmune keratitis * Advanced corneal stromal edema defined as the presence of haze, bullae, or DM folds on slit-lamp biomicroscopy * History of herpes simplex virus or cytomegalovirus keratitis * Prior endothelial keratoplasty * Aphakic in study eye. * Allergy to any component of the Ripasudil hydrochloride hydrate 0.4% that will be used in the course of the study * For women of child-bearing potential: Pregnant or lactating, or planning to become pregnant within the next 6 months. * Any other ocular condition that, in the opinion of the investigator, may preclude the subject from study participation.