Abstract
Purpose To evaluate the morphological features and density of corneal subbasal plexus (SBP) using in vivo corneal confocal microscopy (IVCCM) in patients affected by Fuchs' endothelial corneal dystrophy (FECD) six months after Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK). Methods We included patients affected by FECD, requiring corneal endothelial surgery due to corneal oedema occurred from 3 to 6 months. 7 eyes underwent DMEK and 7 eyes DSAEK. All patients performed IVCCM preoperative and in six months postoperative. We analyzed SBP parameters, using CS4 Nerves Tracking Tool, and we studied the differences between the two endothelial keratoplasties. Results Comparing the eyes treated with DMEK with those treated with DSAEK, preoperative corneal thickness, corrected distance visual acuity (CDVA), and age were similar in both groups. SBP was not detectable at preoperative IVCCM in any eye. Postoperatively, the nerve fibers length, the nerve fibers density, the tortuosity, and the number of fibers and of branching did not differ in the eyes that underwent DMEK compared to DSAEK. The corneal beadings density was higher after DMEK than DSAEK, and this difference was statistically significant (P = 0.004). The type of endothelial keratoplasty was not associated with the presence or absence of postoperative corneal SBP (Pearson' chi-square, 0.755). Conclusions Postoperative corneal reinnervation should be easily and noninvasively studied using IVCCM. Morphological postoperative features of SBP did not differ between two different types of endothelial keratoplasty, DMEK and DSAEK, despite the different sizes of the corneal incision. The lower beading density in the DSAEK group should be the consequence of a different distribution of mitochondria along the nerve fibers, as expression of a supposed higher metabolic distress in the DSAEK group.
Highlights
Fuchs’ endothelial corneal dystrophy (FECD) is a bilateral posterior corneal disease characterized by the loss of corneal endothelial cells and the development of posterior focal guttae, which are caused by Descemet membrane (DM) outgrowth [1]
We found that the corneal nerve fibers length, the nerve fibers density, the tortuosity, and the number of fibers and branching did not differ in patients who underwent Descemet membrane endothelial keratoplasty (DMEK) compared to Descemet-stripping automated endothelial keratoplasty (DSAEK)
Our results showed that the different sizes of corneal incision between DMEK and DSAEK seemed to not affect the main parameters of the corneal subbasal plexus
Summary
Fuchs’ endothelial corneal dystrophy (FECD) is a bilateral posterior corneal disease characterized by the loss of corneal endothelial cells and the development of posterior focal guttae, which are caused by Descemet membrane (DM) outgrowth [1]. The full-thickness penetrating keratoplasty (PK) has been replaced by the posterior lamellar transplantation techniques: Descemet-stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) [5, 6]. Regarding corneal innervation, endothelial keratoplasty is expected to have the ability to preserve fibers, while PK chopped off nerves both of the donor and of the host cornea [11,12,13]. E posterior lamellar surgeries differ from each other in corneal incision size (4.1 mm and 2.8–3.0 in the DSAEK and DMEK, respectively) [7, 9], and this factor should influence the preservation and postoperative recovery of corneal nerves. Erefore, the aim of our study is to evaluate the morphological features and density of SBP using IVCCM in patients affected by FECD at six months after DMEK and DSAEK
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