Abstract
Purpose To provide an objective, quantitative approach for monitoring Fuchs' endothelial corneal dystrophy (FECD), with Scheimpflug imaging. Design This is a retrospective case-control pilot study. Methods The study group consisted of 53 eyes in 27 patients diagnosed with FECD, with normal subjects paired as control. Main outcome measures were corneal thickness, morphological patterns on densitograms, and indices of corneal density including the average area density (mean AD) and the average ratio of Descemet's membrane density versus area density (DM/AD) in Pentacam Scheimpflug images. Results There were no significant differences in age and corneal thickness between FECD and normal groups. Morphologically, hanging-hammock patterns were noted on the densitograms of FECD patients, which were different from the high-back chair patterns in normal subjects. Quantitatively, mean AD and DM/AD were both elevated in FECD patients as compared with normal subjects (P = 0.01 and 0.025, resp.). In addition, FECD patients with corneal edema had significantly higher mean AD (P = 0.018) than those without corneal edema. Conclusions This pilot study shows that Pentacam system provides an objective, quantitative way to approach FECD corneas. It can assist ophthalmologists in detecting the early change and in monitoring disease progression of FECD. Further studies are needed to consolidate the findings.
Highlights
Fuchs’ endothelial corneal dystrophy (FECD), first described by Austrian ophthalmologist Ernst Fuchs [1], is a slowly progressing corneal disorder, characterizing as cornea guttae on the thickened Descemet’s membrane (DM), generalized corneal edema, and decreased visual acuity
Mean Central corneal thickness (CCT) measured with Pentacam were 572.42 μm in FECD patients and 546.62 μm in normal subjects
The hanging-hammock pattern was observed on the densitograms in FECD patients, which was morphologically different from the high-back chair pattern in the normal subjects (Figure 1)
Summary
Fuchs’ endothelial corneal dystrophy (FECD), first described by Austrian ophthalmologist Ernst Fuchs [1], is a slowly progressing corneal disorder, characterizing as cornea guttae on the thickened Descemet’s membrane (DM), generalized corneal edema, and decreased visual acuity. Exact pathogenesis of FECD remains unknown [2]. DM thickening was shown as a result of abnormal collagen band formation secondary to gene mutation histologically [3, 4]. Cornea guttae may cause debilitating glare when it forms into confluence, even when there is little to no stromal or epithelial edema and pachymetry is relatively normal [5]. The Na-K ATPase pump site density in endothelial cells may be decreased progressively in FECD, resulting in stromal edema and eventually full thickness edematous opacity [6, 7]. The etiology of FECD is not fully understood, the genetic factors are suggested to be a major risk factor [7,8,9]
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