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Rizk M, Dubois M, Elahi S, Ghazal W, Flamant R, Tordjmane I, Courtin R, Panthier C, Gatinel D, Saad A. Long-Term Follow-Up of Descemet Stripping Only: Data Up to 7 Years Postoperatively. Cornea 2024; 43:1245-1248. [PMID: 38147577 DOI: 10.1097/ico.0000000000003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE The aim of this study was to report long-term follow-up of eyes undergoing Descemet stripping only (DSO). METHODS This was a retrospective study including 26 eyes of 20 patients undergoing DSO between December 2015 and November 2022. Eligibility criteria included peripheral endothelial cell count (ECC) >1000 cells/mm 2 and symptoms caused by central guttata. Patients underwent a central circular 4-mm descemetorhexis using a reverse Sinskey hook and a pair of descemetorhexis forceps using a peeling technique. Three parameters were measured before surgery and at last follow-up: best-corrected visual acuity (BCVA), central corneal thickness (CCT), and ECC measured centrally and at the periphery. RESULTS The mean age was 73 ± 9 years [52-90 years]. The average follow-up period was 23.7 ± 24.8 months [3-84]. Twenty-two eyes responded to DSO with 20 female eyes (91%) and 2 male eyes (9%). The mean postoperative BCVA improved from 0.3 ± 0.17 logMAR to 0.09 ± 0.13 logMAR ( P value <0.05). The mean postoperative CCT decreased from 588 ± 41 μm to 546 ± 50 μm ( P -value <0.05). The mean postoperative central ECC was 780 ± 257 cells/mm 2 [484-1500]. Peripheral ECC decreased postoperatively (1837 ± 407 cells/mm 2 preoperatively to 864 ± 340 cells/mm 2 postoperatively, P value >0.05). Peripheral endothelial cell polymegathism was stable (average of 26.8% ± 6.8% preoperatively and 30.2% ± 14% postoperatively). Average peripheral endothelial cells polymorphism decreased postoperatively (63.1 ± 20.5% preoperatively to 33% ± 25% postoperatively, P value >0.05). Four eyes did not show improvement after DSO and underwent Descemet membrane endothelial keratoplasty surgery. There were 3 men (75%) and 1 women (25%). The preoperative trend was for nonresponders to have lower BCVA, higher CCT, more abnormal peripheral polymorphism, and polymegathism. CONCLUSIONS The results of this study, with up to 7 years follow up, demonstrate the durability of DSO.
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Affiliation(s)
- Maria Rizk
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
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Belda-Para C, Velarde-Rodríguez G, Marichal-Hernández JG, Velasco-Ocaña M, Trujillo-Sevilla JM, Alejandre-Alba N, Rodríguez-Ramos JM. Fuchs' Endothelial Corneal Dystrophy evaluation using a high-resolution wavefront sensor. Sci Rep 2024; 14:20369. [PMID: 39223223 PMCID: PMC11368916 DOI: 10.1038/s41598-024-71480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024] Open
Abstract
This study aims to evaluate the applicability of the high-resolution WaveFront Phase Imaging Sensor (WFPI) in eyes with Fuchs' Endothelial Corneal Dystrophy (FECD) through qualitative and quantitative analysis using a custom-designed Automatic Guttae Detection Method (AGDM). The ocular phase was measured using the t · eyede aberrometer and then was processed to obtain its High-Pass Filter Map (HPFM). The subjects were pathological and healthy patients from the Fundación Jiménez-Díaz Hospital (Madrid, Spain). The AGDM was developed and applied in pupils with 3 and 5 mm of diameter. A set of metrics were extracted and evaluated like the Root-Mean-Square error (RMS), Number of guttae, Guttae Area, and Area of Delaunay Triangulation (DT). Finally, a Support Vector Machine (SVM) model was trained to classify between pathological and healthy eyes. Quantitatively, the HPFM reveals a dark spots pattern according to the ophthalmologist's description of the slit-lamp examination of guttae distribution. There were significant statistical differences in all the metrics when FECD and Healthy groups were compared using the same pupil size; but comparing both pupil sizes for the same group there were significant differences in most of the variables. This sensor is a value tool to objectively diagnose and monitor this pathology through wavefront phase changes.
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Affiliation(s)
- Carolina Belda-Para
- Wooptix S.L., R &D Section, 38204, La Laguna, Spain
- ESIT, Industrial Engineering Department, Universidad de La Laguna, 38206, La Laguna, Spain
| | | | | | | | | | - Nicolas Alejandre-Alba
- Ophthalmology Department, Hospital Universitario Fundación Jiménez Díaz, 28040, Madrid, Spain
| | - José M Rodríguez-Ramos
- Wooptix S.L., R &D Section, 38204, La Laguna, Spain
- ESIT, Industrial Engineering Department, Universidad de La Laguna, 38206, La Laguna, Spain
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Eleiwa TK, Mohammed MAEA, Bayoumy ASM. Scheimpflug Tomography as a Predictor of Corneal Edema After Phacoemulsification in Fuchs Endothelial Corneal Dystrophy. Clin Ophthalmol 2024; 18:2303-2311. [PMID: 39185362 PMCID: PMC11342942 DOI: 10.2147/opth.s474788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024] Open
Abstract
Purpose To determine if Scheimpflug tomography pachymetry map and posterior elevation map patterns can predict the occurrence of corneal edema following uneventful phacoemulsification surgery in Fuchs endothelial corneal dystrophy (FECD). Design Observational prospective case-control study. Participants Fifty FECD eyes (50 patients) with visually significant cataract: 25 with subclinical corneal edema (SCE) versus 25 without SCE. Methods Preoperatively, FECD was clinically assessed, and only patients devoid of clinical corneal edema were enrolled. Utilizing the Mayo Clinic classification for subclinical corneal edema (SCE), eligible FECD eyes were stratified based on Scheimpflug imaging pachymetry map and posterior elevation map characteristics, including loss of regular isopachs, displacement of the cornea's thinnest point, and the presence of posterior surface depression, into two groups: Group A representing FECD with SCE, and Group B: FECD without SCE. One week postoperatively, clinical and tomographic evaluation was performed. Regression analysis was conducted to evaluate predictors of corneal edema after uneventful phacoemulsification surgery in both groups. Results All patients were successfully imaged before and 1 week after surgery. Visual acuity was significantly improved in both groups (P < 0.001). No postoperative clinical edema was observed in Group B, while 23 (92%) had mild edema and 2 (8%) had moderate edema in Group A. Both groups showed a significant increase in postoperative central corneal thickness (CCT) and thinnest corneal thickness (TCT) (both P < 0.001). Compared to Group B, Group A showed a significant central flattening of the anterior corneal surface (P = 0.007 and P = 0.04 for K1 and K2 respectively), and a significant increase in the postoperative posterior surface depression. Multivariate analysis showed that 94% of postoperative corneal edema could be predicted by the presence of preoperative posterior surface depression (P = 0.04, ARR = 5.8 (1.89-35.7)). Conclusion Scheimpflug tomography pachymetry map and posterior elevation map patterns can predict corneal edema after uneventful phacoemulsification surgery in FECD with subclinical corneal edema.
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Affiliation(s)
- Taher K Eleiwa
- Department of Ophthalmology, Benha University, Benha, Egypt
- Department of Ophthalmology, Magrabi Eye and Dental Hospital, Qassim, Kingdom of Saudi Arabia
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Honda T, Nakagawa T, Yuasa T, Tokuda Y, Nakano M, Tashiro K, Tourtas T, Schlötzer-Schrehardt U, Kruse F, Yamamoto K, Koizumi N, Okumura N. Dysregulation of the TCF4 Isoform in Corneal Endothelial Cells of Patients With Fuchs Endothelial Corneal Dystrophy. Invest Ophthalmol Vis Sci 2024; 65:27. [PMID: 38884552 PMCID: PMC11185267 DOI: 10.1167/iovs.65.6.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/03/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose This study evaluated the dysregulation of TCF4 isoforms and differential exon usage (DEU) in corneal endothelial cells (CECs) of Fuchs endothelial corneal dystrophy (FECD) with or without trinucleotide repeat (TNR) expansion in the intron region of the TCF4 gene. Methods Three RNA-Seq datasets of CECs (our own and two other previously published datasets) derived from non-FECD control and FECD subjects were analyzed to identify TCF4 isoforms and DEU events dysregulated in FECD by comparing control subjects to those with FECD with TNR expansion and FECD without TNR expansion. Results Our RNA-Seq data demonstrated upregulation of three TCF4 isoforms and downregulation of two isoforms in FECD without TNR expansion compared to the controls. In FECD with TNR expansion, one isoform was upregulated and one isoform was downregulated compared to the control. Additional analysis using two other datasets identified that the TCF4-277 isoform was upregulated in common in all three datasets in FECD with TNR expansion, whereas no isoform was dysregulated in FECD without TNR expansion. DEU analysis showed that one exon (E174) upstream of the TNR, which only encompassed TCF4-277, was upregulated in common in all three datasets, whereas eight exons downstream of the TNR were downregulated in common in all three datasets in FECD with TNR expansion. Conclusions This study identified TCF4-277 as a dysregulated isoform in FECD with TNR expansion, suggesting a potential contribution of TCF4-277 to FECD pathophysiology.
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Affiliation(s)
- Tetsuro Honda
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Tatsuya Nakagawa
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Taichi Yuasa
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Yuichi Tokuda
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masakazu Nakano
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Tashiro
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Theofilos Tourtas
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Friedrich Kruse
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Koji Yamamoto
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Naoki Okumura
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
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Kai C, Oie Y, Nishida N, Doi S, Fujimoto C, Asonuma S, Maeno S, Soma T, Koh S, Jhanji V, Kawasaki R, Nishida K. Associations Between Visual Functions and Severity Gradings, Corneal Scatter, or Higher-Order Aberrations in Fuchs Endothelial Corneal Dystrophy. Invest Ophthalmol Vis Sci 2024; 65:15. [PMID: 38848076 PMCID: PMC11166222 DOI: 10.1167/iovs.65.6.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/24/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose The purpose of this study was to investigate the associations between visual function and severity grading, corneal scatter, or higher-order aberrations (HOAs) in patients with Fuchs endothelial corneal dystrophy (FECD). Methods This observational case series study included 49 eyes of 27 patients with FECD and 10 eyes of 10 healthy individuals. We evaluated corrected distance visual acuity (CDVA) using Landolt-C and Early Treatment Diabetic Retinopathy Study charts and contrast sensitivity using the CSV-1000E chart and CSV-1000RN letter chart. We analyzed the associations between visual function and explanatory variables, including age, modified Krachmer grade, central corneal thickness (CCT), anterior segment optical coherence tomography (AS-OCT)-based grade, HOAs, intraocular straylight, and corneal densitometry. We additionally conducted receiver operating characteristic (ROC) analysis to identify the corneal densitometry thresholds for decreased visual function. Results There were significant associations between visual function and the modified Krachmer grade, CCT, AS-OCT-based grade, HOAs, intraocular straylight, and corneal densitometry. A modified Krachmer grade ≥ 3 was identified as a threshold for decreased visual function. Multivariate analysis showed that corneal densitometry was significantly associated with all visual function parameters, and HOAs were significantly associated with CDVA but not with contrast sensitivity. ROC analysis revealed that corneal densitometry of the posterior layer at 0 to 2 mm ≥ 10 grayscale units (GSU), was identified as a threshold for decreased visual function. Conclusions HOAs, forward and backward light scatter affected visual function, with backward light scatter being the most influential. In patients with FECD, modified Krachmer grade ≥ 3 and corneal densitometry ≥ 10 GSU were thresholds for visual disturbance.
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Affiliation(s)
- Chifune Kai
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshinori Oie
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Nozomi Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Suzuka Doi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Chihomi Fujimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sanae Asonuma
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sayo Maeno
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Soma
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shizuka Koh
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Ryo Kawasaki
- Division of Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Patel SV, Hodge DO, Baratz KH. Corneal Backscatter, Pachymetric Indices, and Ectasia Indices for the Assessment of Fuchs Endothelial Corneal Dystrophy. Cornea 2024:00003226-990000000-00568. [PMID: 38830190 DOI: 10.1097/ico.0000000000003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/15/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE To determine whether corneal backscatter, pachymetric indices, and ectasia indices derived from Scheimpflug tomography can identify Fuchs endothelial corneal dystrophy (FECD) corneas with abnormal tomography, the relationships between these parameters and tomographic edema in FECD, and if these parameters help predict improvement in central corneal thickness (CCT) after Descemet membrane endothelial keratoplasty (DMEK). METHODS Tomography maps of 132 eyes of 80 subjects with FECD were analyzed to determine how backscatter, pachymetric, and ectasia parameters compared with the instrument's normative database and if any predicted tomographic edema. Tomography maps from a separate group undergoing DMEK were split into derivation (48 eyes of 39 subjects) and validation (45 eyes of 41 subjects) subgroups to derive a predictive model of improvement in CCT after DMEK. Backscatter, pachymetric, and ectasia parameters were incorporated to determine if the model could be enhanced. RESULTS Among all ectasia, pachymetric, and backscatter parameters, at best only 65% of FECD corneas with definite tomographic edema could be identified based on the instrument's normative database. Among all parameters individually, the highest sensitivity for detecting tomographic edema was 77%. Anterior and mid-corneal backscatter featured in a model predicting improvement in CCT after DMEK with high performance in derivation (R2 = 0.79; 95% confidence interval, 0.65-0.87) and validation (R2 = 0.72; 95% confidence interval, 0.52-0.83) subgroups. CONCLUSIONS The Scheimpflug camera software program could not reliably detect abnormal tomography in FECD from corneal backscatter, pachymetric indices, or ectasia indices. Corneal backscatter contributes to, but does not enhance, a predictive model of improvement in CCT after DMEK.
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Affiliation(s)
- Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, MN; and
| | - David O Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Keith H Baratz
- Department of Ophthalmology, Mayo Clinic, Rochester, MN; and
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Kanclerz P, Bazylczyk N, Przewłócka K, Khoramnia R, Atchison DA, Tuuminen R. Risk Factors for Corneal Monochromatic Aberrations and Implications for Multifocal and Extended Depth-of-Focus Intraocular Lens Implantation. J Refract Surg 2024; 40:e420-e434. [PMID: 38848055 DOI: 10.3928/1081597x-20240416-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE To discuss factors influencing corneal aberrations that might influence the optical quality after intraocular lens (IOL) implantation. METHODS PubMed and Scopus were the main resources used to search the medical literature. An extensive search was performed to identify relevant articles concerning factors influencing the level of corneal aberrations as of August 27, 2023. The following keywords were used in various combinations: corneal, aberrations, defocus, astigmatism, spherical aberration, coma, trefoil, quadrafoil, intraocular lens, and IOL. RESULTS Conclusive evidence is lacking regarding the correlation between age and changes in corneal aberrations. Patients with astigmatism have greater corneal higher-order aberrations than those with minimal astigmatism, particularly concerning trefoil and coma. Increased levels of corneal higher-order aberrations are noted following contact lens wear, in patients with dry eye disease, and with pterygium. Increased higher-order aberrations have been reported following corneal refractive surgery and for 3 months following trabeculectomy; regarding intraocular lens surgery, the results remain controversial. CONCLUSIONS Several factors influence the level of corneal higher-order aberrations. Multifocal and extended depth-of-focus IOLs can share similarities in their optical properties, and the main difference arises in their design and performance with respect to spherical aberration. Preoperative evaluation is critical for proper IOL choice, particularly in corneas with risk of high levels of aberrations. [J Refract Surg. 2024;40(6):e420-e434.].
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Rangu N, Cooke DL, Mittal A, Reinhard T, Wacker K, Langenbucher A, Wendelstein JA, Riaz KM. Comparison of Pre- and Post-DMEK Keratometry and Total Keratometry Values for IOL Power Calculations in Eyes Undergoing Triple DMEK. Curr Eye Res 2024; 49:477-486. [PMID: 38251647 DOI: 10.1080/02713683.2024.2305780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE To evaluate prediction accuracy of pre- and post-DMEK keratometry (K) and total keratometry (TK) values for IOL power calculations in Fuchs endothelial corneal dystrophy (FECD) eyes undergoing DMEK with cataract surgery (triple DMEK). METHODS Retrospective cross-sectional multicenter study of 55 FECD eyes (44 patients) that underwent triple DMEK between 2019 and 2022 between two centers in USA and Europe. Swept-source optical coherence tomography biometry (IOLMaster 700) was used for pre- and post-DMEK measurements. K and TK values were used for power calculations with ten formulae (Barrett Universal II (BUII), Castrop, Cooke K6, EVO 2.0, Haigis, Hoffer Q, Hoffer QST, Holladay I, Kane, and SRK/T). Mean error, mean absolute error (MAE), standard deviation, and percentage of eyes within ±0.50/±1.00 diopters (D) were calculated. Studied formulae were additionally adjusted using a method published previously (IOLup1D Method), which increases the IOL power by 1D. While both eyes from the same patient were considered for descriptive statistics, we restricted to one eye per individual (44 eyes for statistical comparisons. RESULTS MAEs for all formulae were lower for post-DMEK K and TK than pre-DMEK K and TK by an average of 0.24 and 0.47 D, respectively. The lowest MAE was 0.49 D for Kane using post-DMEK TK, and the highest MAE was 1.05 D for BUII using pre-DMEK TK. Most IOLup1D formulae had lower MAEs than pre-DMEK K and TK formulae. CONCLUSIONS The IOLup1D Method should be used instead of pre-DMEK K and TK values for triple DMEK in FECD eyes. Using post-DMEK TK values for cataract surgery after DMEK provides better refractive accuracy than any of the three studied methods used for triple DMEK procedures.
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Affiliation(s)
- Neal Rangu
- College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | | | - Aman Mittal
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Thomas Reinhard
- Eye Center, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katrin Wacker
- Eye Center, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Jascha A Wendelstein
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
- Department for Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
- Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland
| | - Kamran M Riaz
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
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Han SB, Liu YC, Liu C, Mehta JS. Applications of Imaging Technologies in Fuchs Endothelial Corneal Dystrophy: A Narrative Literature Review. Bioengineering (Basel) 2024; 11:271. [PMID: 38534545 DOI: 10.3390/bioengineering11030271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 03/28/2024] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is a complex genetic disorder characterized by the slow and progressive degeneration of corneal endothelial cells. Thus, it may result in corneal endothelial decompensation and irreversible corneal edema. Moreover, FECD is associated with alterations in all corneal layers, such as thickening of the Descemet membrane, stromal scarring, subepithelial fibrosis, and the formation of epithelial bullae. Hence, anterior segment imaging devices that enable precise measurement of functional and anatomical changes in the cornea are essential for the management of FECD. In this review, the authors will introduce studies on the application of various imaging modalities, such as anterior segment optical coherence tomography, Scheimpflug corneal tomography, specular microscopy, in vitro confocal microscopy, and retroillumination photography, in the diagnosis and monitoring of FECD and discuss the results of these studies. The application of novel technologies, including image processing technology and artificial intelligence, that are expected to further enhance the accuracy, precision, and speed of the imaging technologies will also be discussed.
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Affiliation(s)
- Sang Beom Han
- Saevit Eye Hospital, Goyang 10447, Republic of Korea
| | - Yu-Chi Liu
- Singapore National Eye Centre, Singapore 168751, Singapore
- Singapore Eye Research Institute, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Chang Liu
- Singapore Eye Research Institute, Singapore 168751, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore 168751, Singapore
- Singapore Eye Research Institute, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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Thomasy SM, Leonard BC, Greiner MA, Skeie JM, Raghunathan VK. Squishy matters - Corneal mechanobiology in health and disease. Prog Retin Eye Res 2024; 99:101234. [PMID: 38176611 PMCID: PMC11193890 DOI: 10.1016/j.preteyeres.2023.101234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
The cornea, as a dynamic and responsive tissue, constantly interacts with mechanical forces in order to maintain its structural integrity, barrier function, transparency and refractive power. Cells within the cornea sense and respond to various mechanical forces that fundamentally regulate their morphology and fate in development, homeostasis and pathophysiology. Corneal cells also dynamically regulate their extracellular matrix (ECM) with ensuing cell-ECM crosstalk as the matrix serves as a dynamic signaling reservoir providing biophysical and biochemical cues to corneal cells. Here we provide an overview of mechanotransduction signaling pathways then delve into the recent advances in corneal mechanobiology, focusing on the interplay between mechanical forces and responses of the corneal epithelial, stromal, and endothelial cells. We also identify species-specific differences in corneal biomechanics and mechanotransduction to facilitate identification of optimal animal models to study corneal wound healing, disease, and novel therapeutic interventions. Finally, we identify key knowledge gaps and therapeutic opportunities in corneal mechanobiology that are pressing for the research community to address especially pertinent within the domains of limbal stem cell deficiency, keratoconus and Fuchs' endothelial corneal dystrophy. By furthering our understanding corneal mechanobiology, we can contextualize discoveries regarding corneal diseases as well as innovative treatments for them.
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Affiliation(s)
- Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, United States; Department of Ophthalmology & Vision Science, School of Medicine, University of California - Davis, Davis, CA, United States; California National Primate Research Center, Davis, CA, United States.
| | - Brian C Leonard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California - Davis, Davis, CA, United States; Department of Ophthalmology & Vision Science, School of Medicine, University of California - Davis, Davis, CA, United States
| | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States; Iowa Lions Eye Bank, Coralville, IA, United States
| | - Jessica M Skeie
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, United States; Iowa Lions Eye Bank, Coralville, IA, United States
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Weller JM, Bennemann M, Tourtas T, Kruse FE, Schlötzer-Schrehardt U. Differences in Guttae Ultramorphology in Relation to Visual Function in Fuchs Endothelial Corneal Dystrophy. Cornea 2024:00003226-990000000-00500. [PMID: 38391241 DOI: 10.1097/ico.0000000000003504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE The purpose of this study was to investigate the differences in guttae ultramorphology and their relation to visual function in eyes with Fuchs endothelial corneal dystrophy (FECD). METHODS Thirty FECD eyes without ocular comorbidities were included. Visual functional parameters (best-corrected visual acuity with high-contrast and low-contrast letters and contrast sensitivity/LogCS) and corneal morphology measured with Scheimpflug tomography (Pentacam) were assessed. The surgically removed Descemet membranes were examined by light and transmission electron microscopy. RESULTS Preoperative mean best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.52 ± 0.18, LogCS 0.96 ± 0.21 and central corneal thickness 640 ± 55 μm. All eyes had signs of subclinical corneal edema in Scheimpflug tomography; clinically visible corneal edema was present in 40% of eyes. Histological findings included a posterior fibrillar zone (PFZ) in 10 specimens (33%) and abnormal collagen depositions in Descemet membranes in 14 specimens (47%). Guttae buried within the PFZ were present only in eyes with clinically visible edema (n = 4, 13%). There was no difference in visual function results and tomography parameters between eyes with and without PFZ or between protruding guttae and guttae embedded in a PFZ, respectively. CONCLUSIONS Guttae morphology and density were not correlated with visual functional parameters. Guttae buried in a PFZ occurred only in eyes with clinically manifest edema, and thereby, they are an ultramorphological sign for advanced FECD. Subclinical edema was present in all eyes and might be more relevant for quality of vision than guttae ultramorphology.
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Affiliation(s)
- Julia M Weller
- Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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12
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Maeno S, Oie Y, Koto R, Nishida N, Yamashita A, Yoshioka M, Kai C, Soma T, Koh S, Yoshihara M, Kawasaki R, Jhanji V, Nakamori M, Tsujikawa M, Nishida K. Comparison of Scheimpflug and Anterior Segment Optical Coherence Tomography Imaging Parameters for Japanese Patients With Fuchs Endothelial Corneal Dystrophy With and Without TCF4 Repeat Expansions. Cornea 2024:00003226-990000000-00473. [PMID: 38300219 DOI: 10.1097/ico.0000000000003488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE The aim of this study was to investigate the association between cytosine-thymine-guanine trinucleotide repeat (TNR) expansion in TCF4 and the clinical phenotypes of corneal densitometry or anterior segment morphology in Fuchs endothelial corneal dystrophy. METHODS This retrospective cross-sectional study included 150 eyes from 75 Japanese consecutive patients with Fuchs endothelial corneal dystrophy. Cytosine-thymine-guanine repeat expansion of leukocyte-derived genomic DNA was analyzed through fragment analysis using polymerase chain reaction and triplet repeat primed polymerase chain reaction. Scheimpflug-based densitometry and anterior segment optical coherence tomography were applied. Corneal densitometry, and corneal and anterior segment morphology parameters were compared between patients with and without TNR expansion of 50 or more (expansion and nonexpansion groups, respectively) using a mixed model. RESULTS The average age of the patients was 66.8 ± 13.0 years, and the modified Krachmer grading scale was 1, 2, 3, 4, 5, and 6 for 7, 32, 28, 51, 6, and 18 eyes, respectively. Sixteen patients (21%) exhibited ≥50 TNR expansion. No significant differences in sex, age, history of keratoplasty, modified Krachmer grade, and corneal densitometry in either diameter or depth were observed between the 2 groups. No significant differences in anterior segment morphology, including the anterior chamber depth and anterior chamber angle width parameters, were observed using a univariate mixed model, except for central corneal thickness (P = 0.047). However, according to the multivariate mixed model, repeat expansion was not significantly associated with central corneal thickness (P = 0.27). CONCLUSIONS No significant differences in clinical phenotypes were found between Japanese patients having Fuchs endothelial corneal dystrophy with and without TNR expansion.
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Affiliation(s)
- Sayo Maeno
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshinori Oie
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryota Koto
- Department of Biomedical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
- Otsuka Pharmaceutical Co., Ltd., Osaka, Japan
| | - Nozomi Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Arisa Yamashita
- Department of Biomedical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Michika Yoshioka
- Department of Biomedical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Chifune Kai
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Soma
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shizuka Koh
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masahito Yoshihara
- Institute for Advanced Academic Research, Chiba University, Chiba, Japan
- Department of Artificial Intelligence Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Division of Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA; and
| | - Masayuki Nakamori
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Motokazu Tsujikawa
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Biomedical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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13
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Brandi-Dohrn F, Jiang J, Grewing V, Fritz M, Zander D, Lieberum JL, Kladny AM, Siegel H, Bixler S, Müller C, Reinhard T, Wacker K. Diurnal Variation of Visual Acuity and Refraction in Fuchs Endothelial Corneal Dystrophy. Cornea 2024; 43:83-87. [PMID: 37157119 DOI: 10.1097/ico.0000000000003291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/15/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Patients with advanced Fuchs endothelial corneal dystrophy frequently report poor vision in the morning, which improves as the day progresses. This study quantified the amount of variation in near and distance visual acuity and refraction over the course of a day. METHODS This was a prospective cohort study. Best-corrected distance visual acuity and near visual acuity were tested in participants with clinically advanced Fuchs dystrophy and in controls with healthy corneas. Subjective refraction and autorefraction were conducted in a presumed steady state in the afternoon. Measurements were repeated directly after eye opening in the hospital the next morning. In a subgroup, measurements were repeated every 30 minutes for up to 2 hours. RESULTS In Fuchs dystrophy, the mean distance visual acuity was worse by -3 letters (95% confidence interval, -4 to -1) directly after eye opening in the morning compared with late afternoon. No such difference was seen in healthy corneas. In Fuchs dystrophy, visual acuity improved over the course of the study. Visual acuity in the morning could be improved with fine tuning of refraction, and refractive changes were exclusive to Fuchs dystrophy (0.5-1.0 D in spherical equivalent in 30%, >1.0 D in 2% of eyes). CONCLUSIONS Distance and near visual acuity and refraction changes over the course of the day in patients with advanced Fuchs dystrophy. Although small changes in refraction may not usually require a second set of glasses for the first hours of the day, diurnal variation should be considered when determining disease severity in routine practice and in clinical trials.
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Torras-Sanvicens J, Rodríguez-Calvo-de-Mora M, Figueras-Roca M, Amescua G, Carletti P, Casaroli-Marano RP, Patel SV, Rocha-de-Lossada C. Translation and validation of the Visual Function and Corneal Health Status (V-FUCHS) questionnaire into Spanish language. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:9-15. [PMID: 37944642 DOI: 10.1016/j.oftale.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/07/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To translate and validate the V-FUCHS questionnaire into Spanish in a population of patients with Fuchs endothelial dystrophy (DEF). METHODS The V-FUCHS consists of 15 short, easily understandable questions that assess visual aspects of quality of life in patients with DEF, which can be gathered into a group of seven that assess the "Visual Difficulty" factor and another group of eight that assess the "Glare Factor". For the translation and cultural adaptation, the standardized norms for this process were followed, among other phases, a translation, a back-translation and an application in patients with DEF. RESULTS In the first phase, consensus was reached on the Spanish translation of the V-FUCHS. Subsequently, 25 patients were included to carry out the pre-test phase with the aim of assessing the applicability and feasibility of the test. The score obtained a minimum value of -0.88 and a maximum value of +2.44, according to the Rasch probabilistic scale. The mean value obtained from the Visual Difficulty factor was 0.61 (±0.71), while the mean for the Glare Factor was 0.41 (±0.51). CONCLUSION The validation of the V-FUCHS questionnaire, after its translation and adaptation into Spanish, proved to be a useful tool for assessing the visual quality of patients with DEF. Patients with a more advanced stage of the disease presented a greater severity in the test result. Likewise, the Glare Factor (Glare) correlates better with the pachymetric increase than with the visual acuity of the patient.
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Affiliation(s)
- J Torras-Sanvicens
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - M Rodríguez-Calvo-de-Mora
- Qvision, Ophthalmology Department, VITHAS Almería Hospital, Almería, Spain; Ophthalmology Department, VITHAS Málaga, Málaga, Spain; Ophthalmology Department, Hospital Regional Universitario Málaga, Málaga, Spain
| | - M Figueras-Roca
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - G Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, United States; University of Miami-Miller, School of Medicine, Miami, FL, United States
| | - P Carletti
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, United States; University of Miami-Miller, School of Medicine, Miami, FL, United States
| | - R P Casaroli-Marano
- Service of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - S V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - C Rocha-de-Lossada
- Qvision, Ophthalmology Department, VITHAS Almería Hospital, Almería, Spain; Ophthalmology Department, VITHAS Málaga, Málaga, Spain; Ophthalmology Department, Hospital Regional Universitario Málaga, Málaga, Spain; Departamento de Cirugía, Área de Oftalmología, Universidad de Sevilla, Sevilla, Spain.
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15
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Oie Y, Yamaguchi T, Nishida N, Okumura N, Maeno S, Kawasaki R, Jhanji V, Shimazaki J, Nishida K. Systematic Review of the Diagnostic Criteria and Severity Classification for Fuchs Endothelial Corneal Dystrophy. Cornea 2023; 42:1590-1600. [PMID: 37603692 DOI: 10.1097/ico.0000000000003343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/28/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE There are no defined diagnostic criteria and severity classification for Fuchs endothelial corneal dystrophy (FECD), which are required for objective standardized assessments. Therefore, we performed a systematic literature review of the current diagnosis and severity classification of FECD. METHODS We searched the Ovid MEDLINE and Web of Science databases for studies published until January 13, 2021. We excluded review articles, conference abstracts, editorials, case reports with <5 patients, and letters. RESULTS Among 468 articles identified, we excluded 173 and 165 articles in the first and second screenings, respectively. Among the 130 included articles, 61 (47%) and 99 (76%) mentioned the diagnostic criteria for FECD and described its severity classification, respectively. Regarding diagnosis, slitlamp microscope alone was the most frequently used device in 31 (51%) of 61 articles. Regarding diagnostic findings, corneal guttae alone was the most common parameter [adopted in 23 articles (38%)]. Regarding severity classification, slitlamp microscopes were used in 88 articles (89%). The original or modified Krachmer grading scale was used in 77 articles (78%), followed by Adami's classification in six (6%). Specular microscopes or Scheimpflug tomography were used in four articles (4%) and anterior segment optical coherence tomography in one (1%). CONCLUSIONS FECD is globally diagnosed by the corneal guttae using slitlamp examination, and its severity is predominantly determined by the original or modified Krachmer grading scale. Objective severity grading using Scheimpflug or anterior segment optical coherence tomography can be applied in the future innovative therapies such as cell injection therapy or novel small molecules.
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Affiliation(s)
- Yoshinori Oie
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Nozomi Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Naoki Okumura
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan; and
| | - Sayo Maeno
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryo Kawasaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
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16
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Pattan HF, Liu X, Tankam P. Non-invasive in vivo imaging of human corneal microstructures with optical coherence microscopy. BIOMEDICAL OPTICS EXPRESS 2023; 14:4888-4900. [PMID: 37791273 PMCID: PMC10545177 DOI: 10.1364/boe.495242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 10/05/2023]
Abstract
Non-invasive imaging systems with cellular-level resolution offer the opportunity to identify biomarkers of the early stage of corneal diseases, enabling early intervention, monitoring of disease progression, and evaluating treatment efficacy. In this study, a non-contact polarization-dependent optical coherence microscope (POCM) was developed to enable non-invasive in vivo imaging of human corneal microstructures. The system integrated quarter-wave plates into the sample and reference arms of the interferometer to enable deeper penetration of light in tissues as well as mitigate the strong specular reflection from the corneal surface. A common-path approach was adopted to enable control over the polarization in a free space configuration, thus alleviating the need for a broadband polarization-maintained fiber. The POCM achieved volumetric imaging of corneal microstructures, including endothelial cells over a field of view 0.5 × 0.5 mm2 with an almost isotropic resolution of ∼2.2 µm and a volume (500 × 500 × 2048 voxels) rate of 1 Hz. A self-interference approach between the corneal surface and underlying layers was also developed to lessen the corneal curvature and axial motion artifacts, thus enabling high-resolution imaging of microstructures in the anterior cornea, including squamous epithelial cells, wing epithelial cells, basal epithelial cells, sub-basal nerve plexus, and stromal keratocytes.
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Affiliation(s)
- Hadiya F. Pattan
- School of Optometry, Indiana University, Bloomington, IN, 47405, USA
| | - Xiao Liu
- School of Optometry, Indiana University, Bloomington, IN, 47405, USA
| | - Patrice Tankam
- School of Optometry, Indiana University, Bloomington, IN, 47405, USA
- Intelligent Systems Engineering, Luddy School of Informatics, Computing, and Engineering, Indiana University, Bloomington, IN, 47405, USA
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17
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Vieira R, Castro C, Coelho J, Mesquita Neves M, Gomes M, Oliveira L. Descemet Stripping Without Endothelial Keratoplasty in Early-Stage Central Fuchs Endothelial Dystrophy: Long-term Results. Cornea 2023; 42:980-985. [PMID: 36731082 DOI: 10.1097/ico.0000000000003131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to report long-term results of Descemet stripping without endothelial keratoplasty (DWEK) associated with phacoemulsification in patients with early-stage central Fuchs endothelial corneal dystrophy. METHODS This is a retrospective study, including all patients submitted to DWEK associated with cataract surgery with a minimum follow-up of 24 months. Included patients had central confluent guttae confirmed with specular microscopy, a clear peripheral endothelium (with a peripheral endothelial count >1500 cells/mm 2 ), and a central pachymetry <600 μm. The main end points were the presence of a clear cornea and time that was needed to achieve transparency, best-corrected visual acuity in logMAR, endothelial central cell count (ECC), and central pachymetry. RESULTS A total of 22 eyes were included with a mean follow-up of 40.8 ± 10.5 months. At baseline, mean central pachymetry was 536 ± 34 mm and 6 eyes had countable ECC (mean 1138 ± 190 cells/mm 2 ). Twenty eyes (90.9%) achieved good corneal transparency 3.2 ± 1.1 months after surgery. There was a significant improvement in logMAR best-corrected visual acuity compared with baseline (0.13 ± 0.10 vs. 0.48 ± 0.24, respectively, P < 0.001). Endothelial central repopulation was observed in all successful cases. Twelve months after DWEK, ECC was 1449 ± 344 cells/mm 2 and 1393 ± 450 cells/mm 2 at the end of follow-up, without a significant decrease between this period ( P = 0.081). Only 2 eyes (9.1%) did not achieve corneal transparency and were submitted to an endothelial keratoplasty. CONCLUSIONS According to our results, DWEK is a safe and effective procedure in selected cases of early-stage central Fuchs endothelial corneal dystrophy. This seems to be a promising technique, delaying or avoiding endothelial transplantation.
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Affiliation(s)
- Rita Vieira
- Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
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18
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Voncken Santana S, Vasiliauskaitė I, van Dijk K, van Tilborg M, Melles GRJ, Kocaba V, Oellerich S. Impact of Fuchs Endothelial Corneal Dystrophy Severity on Scheimpflug-Derived Parameters After Descemet Membrane Endothelial Keratoplasty. Cornea 2023; 42:970-979. [PMID: 36036666 DOI: 10.1097/ico.0000000000003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate how Scheimpflug-derived parameters of eyes with Fuchs endothelial corneal dystrophy (FECD) are influenced by Descemet membrane endothelial keratoplasty (DMEK) depending on FECD severity and the presence of subclinical edema. METHODS A retrospective cohort study including 115 eyes (115 patients) that underwent DMEK for FECD and a control group of 27 eyes with nonpathological corneas was conducted. Preoperative and 6 months postoperative Scheimpflug imaging was used to analyze pachymetry, presence of tomographic features (loss of isopachs/displacement of the thinnest point/focal posterior depression), and corneal backscatter. FECD severity was based on the modified Krachmer scale and the absence/presence of subclinical edema. RESULTS Scheimpflug-derived pachymetry, tomographic, and corneal backscatter parameters were correlated with FECD severity, and all changed from preoperatively to postoperatively (all P < 0.05). Postoperative central corneal thickness, anterior and posterior corneal backscatter, and presence of focal posterior depression remained different from the control group (all P < 0.05). Of eyes without preoperative clinical edema (n = 75), 18.7% showed 0 or 1 tomographic feature (no edema group) and 82.4% had 2 or 3 features (subclinical edema group). Compared with the control group, postoperative best-corrected visual acuity for the "no edema" group did not differ (0.03 ± 0.12 vs. -0.02 ± 0.08 logarithm of the minimum angle of resolution, P = 0.150) but was worse for the subclinical edema group (0.06 ± 0.08 vs. -0.02 ± 0.08 logarithm of the minimum angle of resolution, P = 0.001). CONCLUSIONS For eyes without preoperative edema, more parameters reversed back to 'normal' levels than for eyes with (sub)clinical edema. Although most analyzed parameters correlated with FECD severity, corneal tomography might be best suited for objective grading of disease severity to aid in surgical decision-making.
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Affiliation(s)
- Stefanie Voncken Santana
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Hogeschool Utrecht, the Netherlands
| | - Indrė Vasiliauskaitė
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, the Netherlands; and
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, the Netherlands; and
| | | | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, the Netherlands; and
| | - Viridiana Kocaba
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, the Netherlands; and
- Tissue and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
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19
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Nakagawa T, Okumura N, Ikegawa M, Toyama Y, Nirasawa T, Mascarelli F, Vaitinadapoule H, Aouimeur I, He Z, Gain P, Thuret G, Koizumi N. Shotgun proteomics identification of proteins expressed in the Descemet's membrane of patients with Fuchs endothelial corneal dystrophy. Sci Rep 2023; 13:10401. [PMID: 37369713 DOI: 10.1038/s41598-023-37104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is a slowly evolving, bilateral disease of the corneal endothelium, characterized by an abnormal accumulation of extracellular matrix (ECM) in the basement membrane (Descemet's membrane, DM). This results in the formation of small round excrescences, called guttae, and a progressive disappearance of endothelial cells. In the intermediate stage, the numerous guttae create significant optical aberrations, and in the late stage, the loss of endothelial function leads to permanent corneal edema. The molecular components of guttae have not been fully elucidated. In the current study, we conducted shotgun proteomics of the DMs, including guttae, obtained from patients with FECD and revealed that 32 proteins were expressed only in the FECD-DMs but not in the DMs of control subjects. Subsequent enrichment analyses identified associations with multiple ECM-related pathways. Immunostaining of flat-mounted DMs confirmed that 4 of the top 5 identified proteins (hemoglobin α, SRPX2, tenascin-C, and hemoglobin γδεβ) were expressed in FECD-DMs but not in non-FECD-DMs. Fibrinogen α was strongly expressed in FECD-DMs, but weakly expressed in non-FECD-DMs. We also demonstrated that matrix-assisted laser desorption ionization imaging mass spectrometry (MALDI-IMS) can display the in situ spatial distribution of biomolecules expressed in the DM, including the guttae.
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Affiliation(s)
- Tatsuya Nakagawa
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, 610-0394, Japan
| | - Naoki Okumura
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, 610-0394, Japan.
| | - Masaya Ikegawa
- Genomics, Proteomics and Biomedical Functions, Graduate School of Life and Medical Sciences, Doshisha University, Kyoto, Japan
| | - Yumiko Toyama
- Genomics, Proteomics and Biomedical Functions, Graduate School of Life and Medical Sciences, Doshisha University, Kyoto, Japan
| | | | - Frederic Mascarelli
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), Faculty of Medicine, Health Innovation Campus, Jean Monnet University, Saint-Étienne, France
- Centre de Recherche des Cordeliers, UMR S1138, Université Paris Descartes, Paris, France
| | - Hanielle Vaitinadapoule
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), Faculty of Medicine, Health Innovation Campus, Jean Monnet University, Saint-Étienne, France
| | - Ines Aouimeur
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), Faculty of Medicine, Health Innovation Campus, Jean Monnet University, Saint-Étienne, France
| | - Zhiguo He
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), Faculty of Medicine, Health Innovation Campus, Jean Monnet University, Saint-Étienne, France
| | - Philippe Gain
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), Faculty of Medicine, Health Innovation Campus, Jean Monnet University, Saint-Étienne, France
- Department of Ophthalmology, University Hospital, Saint-Étienne, France
| | - Gilles Thuret
- Laboratory of Biology, Engineering and Imaging for Ophthalmology (BiiO), Faculty of Medicine, Health Innovation Campus, Jean Monnet University, Saint-Étienne, France
- Department of Ophthalmology, University Hospital, Saint-Étienne, France
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, 610-0394, Japan
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20
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Nakagawa T, Tokuda Y, Nakano M, Komori Y, Hanada N, Tourtas T, Schlötzer-Schrehardt U, Kruse F, Tashiro K, Koizumi N, Okumura N. RNA-Seq-based transcriptome analysis of corneal endothelial cells derived from patients with Fuchs endothelial corneal dystrophy. Sci Rep 2023; 13:8647. [PMID: 37244951 DOI: 10.1038/s41598-023-35468-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/18/2023] [Indexed: 05/29/2023] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is the most common inherited corneal disease. Fibrillar focal excrescences called guttae and corneal edema due to corneal endothelial cell death result in progressive vision loss. Multiple genetic variants have been reported, but the pathogenesis of FECD is not fully understood. In this study, we used RNA-Seq to analyze differential gene expression in the corneal endothelium obtained from patients with FECD. Differential expression analysis of transcriptomic profiles revealed that expression of 2366 genes (1092 upregulated and 1274 downregulated genes) was significantly altered in the corneal endothelium of patients with FECD compared to healthy subjects. Gene ontology analysis demonstrated an enrichment of genes involved in extracellular matrix (ECM) organization, response to oxidative stress, and apoptotic signaling. Several pathway analyses consistently indicated the dysregulation of ECM-associated pathways. Our differential gene expression findings support the previously proposed underlying mechanisms, including oxidative stress and apoptosis of endothelial cells, as well as the phenotypic clinical FECD hallmark of ECM deposits. Further investigation focusing on differentially expressed genes related to these pathways might be beneficial for elucidating mechanisms and developing novel therapies.
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Affiliation(s)
- Tatsuya Nakagawa
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, 610-0394, Japan
| | - Yuichi Tokuda
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masakazu Nakano
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuya Komori
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, 610-0394, Japan
| | - Naoya Hanada
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, 610-0394, Japan
| | - Theofilos Tourtas
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Friedrich Kruse
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Kei Tashiro
- Department of Genomic Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, 610-0394, Japan
| | - Naoki Okumura
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, 610-0394, Japan.
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Tellioğlu A, Beşek NK, Kırgız A, Yılmaz FÖ, Şimşek M, Ahmet S, Atik BK. Changes in Corneal High Order Aberrations and Anterior Chamber Parameters Following Scleral Fixated Intraocular Lens Implantation. Photodiagnosis Photodyn Ther 2023:103595. [PMID: 37146894 DOI: 10.1016/j.pdpdt.2023.103595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/16/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND To evaluate the change in corneal high order aberrations (HOAs) and anterior chamber parameters following scleral fixation in aphakic patients using the Scheimpflug camera system. METHODS This retrospective study included patients who were aphakic after phacoemulsification surgery and underwent scleral-fixed intraocular lens (SF-IOL) implantation with Z suture technique between 2010 and 2022. Preoperative and postoperative best corrected visual acuity (BCVA), anterior segment parameters and corneal aberrations were evaluated with a combined Scheimpflug-Placido disc corneal topography device (Sirius Costruzione Strumenti Oftalmici, Florence, Italy). The following values were recorded: Simulated keratometry (SimK), flat meridian (K1), steep meridian (K2), iridocorneal angle (ICA), temporal anterior chamber angle (T-ACA), nasal anterior chamber angle (N-ACA), horizontal anterior chamber diameter (HACD), anterior chamber volume (ACV), corneal volume (CV), total Root Mean Square (RMS), high order aberrations (HOAs), spherical aberration, coma, trefoil, quadrifoil, and secondary astigmatism. RESULTS The study included 31 eyes of 31 patients (mean age: 63.00±19.41 years, 17 males/14 females). Postoperative BCVA was better than preoperative BCVA (p=0.012). Postoperatively, there was a statistically significant increase in ACV and CV values and a statistically significant decrease in K2 (p=0.009, p=0.032, p=0.015). Preoperative T-ACA and preoperative and postoperative ACV were negatively correlated with postoperative intraocular pressure (r=-0.427 p=0.033, r=-0.406 p=0.032 and r=-0.561 p=0.001). There were statistically significant postoperative increases in corneal RMS, trefoil and HOAs for 3 mm pupil diameter (p=0.0177, p=0.001, p=0.031) and in corneal RMS, trefoil and quadrifoil aberrations for 6 mm pupil diameter (p=0.033, p=0.001, p=0.001). CONCLUSIONS In conclusion, SF-IOL implantation with Z-suture technique used for visual rehabilitation of aphakic patients may affect visual quality by increasing corneal HOAs while improving visual acuity.
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Affiliation(s)
- Adem Tellioğlu
- Department of Ophtalmology, Soma State Hospital, Manisa, Turkiye.
| | - Nilay Kandemir Beşek
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Ahmet Kırgız
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Fevziye Öndeş Yılmaz
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Metehan Şimşek
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Sibel Ahmet
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
| | - Burcu Kemer Atik
- University of Health Sciences, Turkey; Beyoglu Eye Training and Research Hospital.
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Rong H, Liu L, Liu Y, Fu W, Xu H, Yu D, Wu D, Du B, Zhang X, Zhang B, Wei R. Quantifying the morphology of eyeballs with posterior staphyloma with Zernike polynomials. Front Bioeng Biotechnol 2023; 11:1126543. [PMID: 36970611 PMCID: PMC10034088 DOI: 10.3389/fbioe.2023.1126543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
Purpose: To quantify the morphology of eyeballs with posterior staphyloma (PS) with Zernike decomposition and to explore the association between Zernike coefficients with existing PS classification.Methods: Fifty-three eyes with high myopia (HM, ≤-6.00D) and 30 with PS were included. PS was classified with traditional methods based on OCT findings. Eyeballs’ morphology was obtained with 3D MRI, from which the height map of the posterior surface was extracted. Zernike decomposition was performed to derive the coefficients of the 1st-27th items, which were compared between HM and PS eyes with the Mann-Whitney-U test. Receiver operating characteristics (ROC) analysis was used to test the effectiveness of using Zernike coefficients to discriminate PS from HM.Results: Compared to HM eyeballs, PS eyeballs had significantly increased vertical and horizontal tilt, oblique astigmatism, defocus, vertical and horizontal coma, and higher order aberrations (HOA) (all Ps < 0.05). HOA was the most effective in PS classification with an area under the ROC curve (AUROC) value of 0.977. Among the 30 PS, 19 were the wide macular type with large defocus and negative spherical aberration; 4 were the narrow macular type with positive spherical aberration; 3 were inferior PS with greater vertical tilt, and 4were peripapillary PS with larger horizontal tilt.Conclusion: PS eyes have significantly increased Zernike coefficients, and HOA is the most effective parameter to differentiate PS from HM. The geometrical meaning of the Zernike components showed great accordance with PS classification.
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Affiliation(s)
- Hua Rong
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Lin Liu
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yuling Liu
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | | | - He Xu
- Department of Radiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Danyang Yu
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Di Wu
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Bei Du
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xuejun Zhang
- Department of Radiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Bin Zhang
- College of Optometry, Nova Southeastern University, Davie, FL, United States
- *Correspondence: Bin Zhang, ; Ruihua Wei,
| | - Ruihua Wei
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- *Correspondence: Bin Zhang, ; Ruihua Wei,
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Anterior Corneal High-order Aberrations in Fuchs' Endothelial Corneal Dystrophy Classified by Scheimpflug Tomography. Optom Vis Sci 2023; 100:151-157. [PMID: 36728707 DOI: 10.1097/opx.0000000000001981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SIGNIFICANCE Visual acuity may be limited after endothelial keratoplasty in Fuchs' endothelial corneal dystrophy. This may be due to increased anterior high-order aberrations that persist after endothelial keratoplasty. It is not clear at what stage these aberrations begin. We aimed to evaluate how subclinical corneal edema affects anterior corneal high-order aberrations. PURPOSE We aimed to evaluate anterior corneal high-order aberrations according to the presence of subclinical corneal edema in Fuchs' endothelial corneal dystrophy using Scheimpflug topography. METHODS All the patients underwent corneal topography (Sirius Scheimpflug-Placido disc camera; CSO Ophthalmic, Scandicci, Italy). Fifty-two eyes of 31 patients with Fuchs' endothelial corneal dystrophy and 52 eyes of 35 patients without corneal problems were included. In addition, patients with Fuchs' endothelial corneal dystrophy were divided into two groups according to subclinical corneal edema as with Fuchs' endothelial corneal dystrophy-edema and Fuchs' endothelial corneal dystrophy-nonedema. Subclinical corneal edema was defined based on the presence of at least two of three findings of the loss of regular isopachs, displacement of the thinnest point of the cornea, and posterior depression. High-order aberrations were expressed as Zernike polynomials in the 4- and 6-mm optical zone. RESULTS We found that subclinical corneal edema in Fuchs' endothelial corneal dystrophy caused a larger 4-mm trefoil II and a smaller 6-mm spherical aberration II measurements than the nonedema group. The 6-mm total high-order aberrations, 6-mm coma aberration, and 4- and 6-mm trefoil II aberration measurements were larger, and the 6-mm spherical aberration II was smaller in Fuchs' endothelial corneal dystrophy patients with edema compared with the healthy eyes. CONCLUSIONS The presence of subclinical corneal edema in Fuchs' endothelial corneal dystrophy results in larger 4-mm trefoil II and smaller 6-mm spherical aberration II measurements. More patients with intermediate values are needed to evaluate the effect of these aberrations on visual acuity.
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Loss of Corneal Nerves and Corneal Haze in Patients with Fuchs' Endothelial Corneal Dystrophy with the Transcription Factor 4 Gene Trinucleotide Repeat Expansion. OPHTHALMOLOGY SCIENCE 2022; 3:100214. [PMID: 36275201 PMCID: PMC9563205 DOI: 10.1016/j.xops.2022.100214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/30/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022]
Abstract
Objective Seventy percent of Fuchs' endothelial corneal dystrophy (FECD) cases are caused by an intronic trinucleotide repeat expansion in the transcription factor 4 gene (TCF4). The objective of this study was to characterize the corneal subbasal nerve plexus and corneal haze in patients with FECD with (RE+) and without the trinucleotide repeat expansion (RE-) and to assess the correlation of these parameters with disease severity. Design Cross-sectional, single-center study. Participants Fifty-two eyes of 29 subjects with a modified Krachmer grade of FECD severity from 1 to 6 were included in the study. Fifteen of the 29 subjects carried an expanded TCF4 allele length of ≥ 40 cytosine-thymine-guanine repeats (RE+). Main Outcomes Measures In vivo confocal microscopy assessments of corneal nerve fiber length (CNFL), corneal nerve branch density, corneal nerve fiber density (CNFD), and anterior corneal stromal backscatter (haze); Scheimpflug tomography densitometry measurements of haze in anterior, central, and posterior corneal layers. Results Using confocal microscopy, we detected a negative correlation between FECD severity and both CNFL and CNFD in the eyes of RE+ subjects (Spearman ρ = -0.45, P = 0.029 and ρ = -0.62, P = 0.0015, respectively) but not in the eyes of RE- subjects. Additionally, CNFD negatively correlated with the repeat length of the expanded allele in the RE+ subjects (Spearman ρ = -0.42, P = 0.038). We found a positive correlation between anterior stromal backscatter and severity in both the RE+ and RE- groups (ρ = 0.60, P = 0.0023 and ρ = 0.44, P = 0.024, respectively). The anterior, central, and posterior Scheimpflug densitometry measurements also positively correlated with severity in both the RE+ and RE- groups (P = 5.5 × 10-5, 2.5 × 10-4, and 2.9 × 10-4, respectively, after adjusting for the expansion status in a pooled analysis. However, for patients with severe FECD (Krachmer grades 5 and 6), the posterior densitometry measurements were higher in the RE+ group than in the RE- group (P < 0.05). Conclusions Loss of corneal nerves in FECD supports the classification of the TCF4 trinucleotide repeat expansion disorder as a neurodegenerative disease. Haze in the anterior, central, and posterior cornea correlate with severity, irrespective of the genotype. Quantitative assessments of corneal nerves and corneal haze may be useful to gauge and monitor FECD disease severity in RE+ patients.
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Visual Function in Pseudophakic Eyes with Fuchs' Endothelial Corneal Dystrophy. Am J Ophthalmol 2022; 239:98-107. [PMID: 35123953 DOI: 10.1016/j.ajo.2022.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess vision in pseudophakic eyes with Fuchs' endothelial corneal dystrophy (FECD) before the onset of clinically detectable corneal edema. DESIGN Cross-sectional study. METHODS Sixty-one otherwise healthy pseudophakic eyes of 38 subjects with FECD (without clinically detectable edema) and 17 otherwise healthy pseudophakic eyes of 9 subjects with normal corneas. Subjects underwent clinical examination to determine the morphologic distribution of guttae (severity grading). Standardized best-corrected high-contract and low-contrast (photopic and mesopic) visual acuity (HCVA, LCVA) and straylight were measured. Scheimpflug tomography posterior elevation and pachymetry maps were interpreted for 3 tomographic features of subclinical edema: loss of regular isopachs, displacement of the thinnest point of the cornea, and presence of posterior surface depression. RESULTS In FECD without tomographic features of edema (ie, normal tomography patterns), HCVA, LCVA, and straylight did not differ from that of eyes with normal corneas (P ≥ .09); these eyes encompassed the full range of severity grading of guttae. In FECD with all 3 tomographic features of edema, the same parameters were worse compared with eyes with normal corneas (P ≤ .02). In FECD with 1 or 2 tomographic abnormalities, mesopic LCVA (P = .04) and straylight (P = .003) were worse compared with eyes with normal corneas. CONCLUSIONS Impairment of vision was associated with the presence of tomographic edema in eyes with FECD. When tomography patterns were normal in FECD (ie, guttae were present without tomographic edema), visual acuity and straylight were normal, and therefore corneal surgical intervention would not typically be indicated to improve vision.
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Schmitz L, Safi T, Munteanu C, Seitz B, Daas L. Prevalence and severity of cornea guttata in the graft following Descemet Membrane Endothelial Keratoplasty (DMEK). Acta Ophthalmol 2022; 100:e1737-e1745. [PMID: 35652475 DOI: 10.1111/aos.15195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine the prevalence and severity of cornea guttata (CG) in grafts after Descemet membrane endothelial keratoplasty (DMEK) and to investigate its impact on various clinical parameters during follow-up. METHODS This retrospective study included 664 operations (DMEK and triple-DMEK) on 466 patients. The prevalence and progression of CG after the operation were examined using endothelial specular microscopy images. The severity grade of CG was classified into four grades: G0 without CG, G1 - G3 with increasing severity of CG. Clinical parameters such as central corneal thickness (CCT), visual acuity (VA), endothelial cell density (ECD), pleomorphism and polymegalism were examined during a postoperative follow-up time of 19.6 ± 15.8 months. RESULTS Cornea guttata (CG) appeared postoperatively in 124 (18.7%) eyes. 112 (16.9%) could be classified as G1, 9 (1.4%) as G2 and only 3 (0.5%) as G3. The examination of clinical parameters showed significant differences between healthy and low-grade CG (G0/G1) and high-grade CG (G2/G3). A significant deterioration was found in the corrected distance visual acuity (CDVA) (p = 0.02). CCT showed an increase between G0 (534 ± 58 μm) and G2 (549 ± 71 μm)/G3 (558 ± 56 μm) with a p-value of 0.02. Additionally, a significant increase in pleomorphism (p = 0.003) and polymegalism (p = 0.04) was detected. CONCLUSION Cornea guttata (CG) prevalence after DMEK and triple-DMEK was found to be 18.7%, although most of these cases were classified as low-grade CG and showed no clinical significance. Around 1.9% were classified as high-grade CG and significantly affected several clinical parameters during the follow-up.
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Affiliation(s)
- Lena‐Marie Schmitz
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
| | - Tarek Safi
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
| | - Cristian Munteanu
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
| | - Berthold Seitz
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
| | - Loay Daas
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
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Patel SV, Camp JJ, Hodge DO, Baratz KH, Holmes DR. Predicting Corneal Improvement after Descemet Membrane Endothelial Keratoplasty for Fuchs Endothelial Corneal Dystrophy. OPHTHALMOLOGY SCIENCE 2022; 2:100128. [PMID: 36249689 PMCID: PMC9560526 DOI: 10.1016/j.xops.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/21/2022] [Accepted: 02/15/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To develop a model to predict corneal improvement after Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial corneal dystrophy (FECD) from Scheimpflug tomography. DESIGN Cross-sectional study. PARTICIPANTS Forty-eight eyes (derivation group) and 45 eyes (validation group) with a range of severity of FECD undergoing DMEK. METHODS Scheimpflug images were obtained before and after DMEK. Before DMEK, pachymetry map and posterior elevation map patterns were quantified by a special image analysis program measuring tomographic features of edema (loss of regular isopachs, displacement of the thinnest point of the cornea, posterior surface depression). Image-derived novel parameters were combined with instrument-derived parameters, and the relative influences of parameters associated with the change in central corneal thickness (CCT) after DMEK in the derivation group were determined by using a gradient boosting machine learning model. The parameters with highest relative influence were then fit in a linear regression model. The derived model was applied to the validation group. Correlations and agreement were assessed between predicted and observed changes in CCT. MAIN OUTCOME MEASURES Predictive power (R 2) and mean difference between predicted and observed change in CCT. RESULTS The gradient boosting machine model identified 4 novel parameters of isopach circularity and eccentricity and 1 instrument-derived parameter (posterior surface radius); preoperative CCT was a poor predictor. In the derivation group, the model strongly predicted the change in CCT after DMEK (R 2 = 0.80; 95% confidence interval [CI], 0.71-0.89) and the mean difference between predicted and observed change was, by definition, 0 μm. When the same 5 parameters were fit to the validation group, the model performed very highly (R 2 = 0.89; 95% CI, 0.84-0.94). When the coefficient estimates from the derivation model were used to predict the change in CCT in the validation group, the predictive power was also high (R 2 = 0.78; 95% CI, 0.68-0.88), and the mean difference was 4 μm (predicted minus observed). CONCLUSIONS Scheimpflug tomography maps of corneas with FECD can predict the improvement in CCT after DMEK, independent of preoperative corneal thickness measurement. The model could be applied in clinical practice or for clinical research of FECD.
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Affiliation(s)
- Sanjay V. Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Jon J. Camp
- Biomedical Imaging Resource, Mayo Clinic, Rochester, Minnesota
| | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Keith H. Baratz
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - David R. Holmes
- Biomedical Imaging Resource, Mayo Clinic, Rochester, Minnesota
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Shah K, Eghrari AO, Vanner EA, O'Brien TP, Koo EH. Scheimpflug Corneal Densitometry Values and Severity of Guttae in Relation to Visual Acuity in Fuchs Endothelial Corneal Dystrophy. Cornea 2022; 41:692-698. [PMID: 35175018 PMCID: PMC8857507 DOI: 10.1097/ico.0000000000002762] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the association between corneal densitometry (CD) values from Scheimpflug tomography imaging, severity of guttae, and visual acuity in eyes with Fuchs endothelial corneal dystrophy (FECD). METHODS This was a retrospective, cross-sectional study. Patients with FECD were examined at the Bascom Palmer Eye Institute from January 2015 to September 2019. We extracted CD values at central annuli of 0-2, 2-6, 6-10 and 10-12 mm from Scheimpflug tomography images. We investigated the association of corrected distance visual acuity (CDVA) with CD values, severity of guttae, central corneal thickness (CCT), cataract grade, refractive error, corneal edema grade, age, and gender using multivariate generalized estimating equation regression models. RESULTS One hundred ninety-two eyes from 110 patients were included in this study. Increase in central CD values at the 0 to 2 mm zone (P < 0.001), severity of guttae (P = 0.046), age (P < 0.001), cataract grade (P < 0.001), corneal edema grade (P < 0.001), and type of refractive error (P = 0.008) were significantly associated with decreased CDVA. Central corneal thickness, sex, and the peripheral CD values (2-6, 6-10, and 10-12 mm) were not significantly associated with CDVA (P > 0.05) in the final multivariate regression model. CONCLUSIONS Our study demonstrates that central CD values at 0 to 2 mm and severity of guttae are each associated with decreased CDVA in FECD. These findings carry implications for patients with FECD considering surgical intervention for phacoemulsification alone, Descemet stripping only, or endothelial cell transplantation and provide a multifactorial perspective on vision loss in FECD.
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Affiliation(s)
- Khushali Shah
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Allen O Eghrari
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Terrence P O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
| | - Ellen H Koo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; and
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Özer O, Mestanoglu M, Howaldt A, Clahsen T, Schiller P, Siebelmann S, Reinking N, Cursiefen C, Bachmann B, Matthaei M. Correlation of Clinical Fibrillar Layer Detection and Corneal Thickness in Advanced Fuchs Endothelial Corneal Dystrophy. J Clin Med 2022; 11:jcm11102815. [PMID: 35628952 PMCID: PMC9144691 DOI: 10.3390/jcm11102815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
Central subendothelial geographic deposits are formed as a fibrillar layer (FL) in advanced Fuchs endothelial corneal dystrophy (FECD). Previous studies demonstrated a significant decrease in corneal endothelial cell (CEC) density and an increase in focal corneal backscatter in the FL area. The present study investigated the association of the FL with edema formation and its localization. Patients (n = 96) presenting for Descemet membrane endothelial keratoplasty (DMEK) for advanced FECD were included. Slit-lamp biomicroscopy with FECD grading was followed by Scheimpflug imaging with en face backscatter analysis and pachymetric analysis. FL dimensions were measured, and correlation with pachymetric values was performed. An FL was detected in 74% of all eyes (n = 71). Pachymetric values in FL-positive versus FL-negative eyes were for corneal thickness at the apex (ACT) 614 ± 52 µm and 575 ± 46 µm (p = 0.001), for peripheral corneal thickness at 1 mm (PCT1mm) 616 ± 50 µm and 580 ± 44 µm (p = 0.002), for PCT2mm 625 ± 48 µm and 599 ± 41 µm (p = 0.017), for PCT3mm 651 ± 46 µm and 635 ± 40 µm (p = 0.128) and for PCT4mm 695 ± 52 µm and 686 ± 43 µm (p = 0.435), respectively. Correlation analysis indicated a weak correlation for the FL maximum vertical caliper diameter with ACT and PCT1mm values but no further relevant correlations. In FL-positive eyes, increased focal corneal backscatter and increased corneal thickness showed primarily central and inferotemporal localization. In conclusion, Scheimpflug imaging shows an association of the FL with increased corneal thickness in advanced FECD and shows localization of the FL and increased corneal thickness in the central and inferotemporal region. This may provide important information for progression assessment and therapeutic decision making in FECD patients in the future.
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Affiliation(s)
- Orlando Özer
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
- Eye Center Seufert, 51427 Bergisch Gladbach, Germany
| | - Mert Mestanoglu
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
| | - Antonia Howaldt
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
| | - Thomas Clahsen
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Petra Schiller
- Institute for Medical Statistics and Bioinformatics, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Sebastian Siebelmann
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
| | - Niklas Reinking
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Björn Bachmann
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
| | - Mario Matthaei
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (O.Ö.); (M.M.); (A.H.); (T.C.); (S.S.); (N.R.); (C.C.); (B.B.)
- Correspondence:
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Hribek A, Mestanoglu M, Clahsen T, Reinking N, Frentzen F, Howaldt A, Siebelmann S, Bachmann BO, Cursiefen C, Matthaei M. Scheimpflug Backscatter Imaging of the Fibrillar Layer in Fuchs Endothelial Corneal Dystrophy. Am J Ophthalmol 2022; 235:63-70. [PMID: 34509435 DOI: 10.1016/j.ajo.2021.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
A central collagen-rich subendothelial fibrillar layer (FL) correlates with areas of accentuated loss of corneal endothelial cells in advanced Fuchs endothelial corneal dystrophy (FECD). The present study sought to investigate whether the FL may be visualized by en face Scheimpflug backscatter imaging in vivo. DESIGN Retrospective analysis of a prospective observational case series. METHODS A total of 34 eyes (34 subjects) undergoing Descemet membrane endothelial keratoplasty (DMEK) surgery with preoperative high-quality Scheimpflug backscatter imaging data were included. The Descemet endothelium complex (DEC) was retrieved during DMEK surgery, and immunofluorescence staining was performed for collagens I, III, and IV. The FL morphology in en face Scheimpflug backscatter and immunofluorescence imaging was compared and agreement of FL parameters was analyzed using intraclass correlation coefficients (ICC) and Bland-Altman plots. RESULTS Scheimpflug backscatter imaging delineated the FL in 26 eyes and was FL negative in 8 eyes with deviation compared to immunofluorescence in 1 case and good agreement of morphology characteristics. Horizontal caliper diameter ± SD was 4.84 ± 0.85 mm, vertical caliper diameter was 3.92 ± 0.78 mm, maximum caliper diameter was 5.12 ± 0.82 mm, and surface area was 12.43 ± 4.74 mm2. Compared to immunofluorescence imaging, mean difference (95% limits of agreement) and intraclass correlation coefficients were for horizontal caliper diameter 0.13 mm (-0.81 to 1.1 mm) and 0.88, vertical caliper diameter 0.23 mm (-0.76 to 1.2 mm) and 0.81, maximum caliper diameter 0.06 mm (-1.1 to 1.2 mm) and 0.86, and surface area 1.4 mm2 (-3.9 to 6.7 mm2) and 0.85. CONCLUSIONS Scheimpflug backscatter imaging facilitates visualization of the FL in advanced FECD eyes, offering the potential to identify particularly diseased areas of the FECD endothelium in vivo.
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Chaussard D, Bloch F, Elnar AA, Zevering Y, Vermion JC, Moskwa R, Perone JM. Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study. PLoS One 2022; 17:e0264401. [PMID: 35202443 PMCID: PMC8870504 DOI: 10.1371/journal.pone.0264401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Low postoperative endothelial-cell density (ECD) plays a key role in graft failure after Descemet-membrane endothelial keratoplasty (DMEK). Identifying pre/perioperative factors that predict postoperative ECD could help improve DMEK outcomes. This retrospective study was conducted with consecutive adult patients with Fuchs-endothelial corneal dystrophy who underwent DMEK in 2015–2019 and were followed for 12 months. Patients underwent concomitant cataract surgery (triple-DMEK) or had previously undergone cataract surgery (pseudophakic-DMEK). Multivariate analyses assessed whether: patient age/sex; graft-donor age; preoperative ECD, mean keratometry, or visual acuity; triple DMEK; surgery duration; surgical difficulties; and need for rebubbling predicted 6- or 12-month ECD in the whole cohort or in subgroups with high/low ECD at 6 or 12 months. The subgroups were generated with the clinically relevant threshold of 1000 cells/mm2. Surgeries were defined as difficult if any part was not standard. In total, 103 eyes (95 patients; average age, 71 years; 62% women) were included. Eighteen eyes involved difficult surgery (14 difficult graft preparation or unfolding cases and four others). Regardless of how the study group was defined, the only pre/perioperative variable that associated significantly with 6- and 12-month ECD was difficult surgery (p = 0.01, 0.02, 0.05, and 0.0009). Difficult surgery also associated with longer surgery duration (p = 0.002). Difficult-surgery subgroup analysis showed that difficult graft dissection associated with lower postoperative ECD (p = 0.03). This association may reflect endothelial cell loss due to excessive graft handling and/or an intrinsic unhealthiness of the endothelial cells in the graft that conferred unwanted physical properties onto the graft that complicated its preparation/unfolding.
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Affiliation(s)
- Dimitri Chaussard
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Florian Bloch
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Arpiné Ardzivian Elnar
- Clinical Research Support Unit, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville Regional Hospital Center, Metz, France
| | - Yinka Zevering
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Rémi Moskwa
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
| | - Jean-Marc Perone
- Ophthalmology Department, Mercy Hospital, Regional Hospital Center (CHR) of Metz-Thionville, Metz, France
- Institut Jean Lamour, Lorraine University, Nancy, France
- * E-mail:
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Retinometer predicts visual outcome in Descemet membrane endothelial keratoplasty. Graefes Arch Clin Exp Ophthalmol 2022; 260:2283-2290. [PMID: 35218379 PMCID: PMC9203399 DOI: 10.1007/s00417-022-05605-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To analyze the preoperative predictive value of retinometer visual acuity (VA) in eyes following Descemet membrane endothelial keratoplasty (DMEK). METHODS Patients undergoing DMEK between August 2011 and July 2020 were included. Preoperative interference visual acuity was assessed using Heine Lambda 100 Retinometer. Depending on the presence or absence of concomitant ocular disease, the Retinometer was evaluated for its ability to preoperatively predict best-corrected visual acuity (BCVA) six months after surgery using correlation, simple and multiple linear regression, contingency analyses, and receiver operating characteristic (ROC) analysis. Preoperative corneal backscatter was correlated with Retinometer prediction accuracy. RESULTS A total of 198 eyes were included in the analysis. There was a significant correlation between Retinometer VA and postoperative BCVA (r = 0.647, P < 0.001). Regardless of the presence or absence of concomitant ocular disease and the surgery procedure (DMEK & triple DMEK), Retinometer VA was the most significant predictor of postoperative BCVA (P < 0.001). ROC analysis revealed reliable diagnostic performance of the Retinometer (AUC = 0.829, P < 0.001). A Retinometer VA ≥ 0.5 accurately predicted a postoperative BCVA ≥ 0.5 in 91% of cases. No association was found between corneal backscatter and prediction accuracy (P = 0.566). CONCLUSIONS Retinometer VA can be used for preoperative prediction of postoperative BCVA in DMEK and triple DMEK patients, independent of increased backscatter values and the presence or absence of concomitant ocular disease. By using this simple but effective tool, indication for DMEK can be facilitated and postoperative outcomes can be realistically predicted preoperatively.
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Patel SV. Imaging Fuchs Endothelial Corneal Dystrophy in Clinical Practice and Clinical Trials. Cornea 2021; 40:1505-1511. [PMID: 34074894 DOI: 10.1097/ico.0000000000002738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Corneal tomography has an emerging role in the assessment of Fuchs endothelial corneal dystrophy (FECD) in clinical practice and potentially for future clinical trials. Posterior elevation and pachymetry maps derived from elevation based Scheimpflug tomography can detect early corneal edema, even at a subclinical stage, enabling clinicians to better counsel patients about their vision and the risk of disease progression with and without cataract surgery. Tomographic imaging provides a functional assessment of corneal endothelial health, and could enable objective assessment of FECD progression, or regression, in response to novel therapeutic interventions. Clinicians and investigators should adopt Scheimpflug imaging for the assessment of FECD over traditional morphologic imaging modalities.
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Bonnet C, Vazirnia P, Deng SX, Aldave AJ, Miller KM. Sutured Custom Foldable Silicone Artificial Iris Implantation Combined With Intraocular Lens Implantation and Penetrating Keratoplasty: Safety and Efficacy Outcomes. Cornea 2021; 40:1236-1247. [PMID: 33086281 PMCID: PMC8423143 DOI: 10.1097/ico.0000000000002564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess safety and efficacy outcomes of sutured custom silicone artificial iris and intraocular lens implantation combined with penetrating keratoplasty (triple procedure). METHODS Prospective consecutive surgical case series of patients who underwent the triple procedure between 2010 and 2019 at Stein Eye Institute, UCLA, followed up for 1 year minimum. Safety outcomes were changes from preoperative to last follow-up in corrected distance visual acuity (CDVA), endothelial cell count, intraocular pressure (IOP), and postoperative complications. Efficacy outcomes included changes in subjective glare (none to severe), cosmetic appearance (worse to very much improved), and visual function as assessed by the Visual Function Questionnaire-25 at 1-year follow-up. RESULTS Among 82 eyes implanted with an artificial iris, 14 eyes (17.1%) underwent the triple procedure. The median follow-up was 18.1 months (range 12.0-54.9 months). The median CDVA improved from 2.0 log of minimum angle of resolution (logMAR) (range 0.9-2.3 logMAR) to 0.7 logMAR (range 0.2-2.6 logMAR) (P = 0.02). Average endothelial cell count decreased 57.6% (P < 0.01). Six eyes (42.9%) experienced IOP elevations, 13 eyes (92.3%) developed iritis, and 11 eyes (78.6%) underwent secondary surgery. Graft rejection or secondary graft failure occurred in 7 eyes each (50.0%). Cosmesis improved in 12 eyes (85.7%; P < 0.01). The Visual Function Questionnaire-25 score improved from 72 to 77 (P < 0.01). Glare symptoms did not change significantly. CONCLUSIONS The triple procedure was effective at improving CDVA, cosmesis, and quality of life; however, it was associated with frequent postoperative complications, of which iritis, IOP elevation, and secondary graft failure were the most common.
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Affiliation(s)
- Clemence Bonnet
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
- Université de Paris, AP-HP Hôpital Cochin, Paris, France
| | - Parsia Vazirnia
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Sophie X. Deng
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Anthony J. Aldave
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
| | - Kevin M. Miller
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA; and
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Walckling M, Waterstradt R, Baltrusch S. Collagen Remodeling Plays a Pivotal Role in Endothelial Corneal Dystrophies. Invest Ophthalmol Vis Sci 2021; 61:1. [PMID: 33259606 PMCID: PMC7718819 DOI: 10.1167/iovs.61.14.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose To elucidate the collagen structure in the Descemet membrane (DM) of the human cornea and to characterize its rearrangement in patients with endothelial corneal dystrophies. Methods Corneas from nine human donors and dystrophic DMs removed from 16 affected eyes of 13 patients by endothelial keratoplasty (DMEK) were investigated using a correlative RT-qPCR and label-free two-channel multiphoton microscopy (MPM) setup. Although collagen formation was visualized by second harmonic generation, the cellular structure was determined by autofluorescence. Results The DM of the human donor cornea was characterized by a consistent pattern of fine hexagonal collagen structures that form a supportive scaffold for the endothelial cells. Accordingly, network-forming collagens (8A1 and 8A2) but less fibrillar collagens (only 1A2) were expressed. DMEK resulted in significant (P < 0.0001) improvement of best-corrected visual acuity. In the removed dystrophic DMs, MPM analyses revealed collagen rearrangement in addition to loss of endothelial cells and the development of guttae. MPM analyses of the whole patient's DM demonstrated this collagen remodeling in its entirety and facilitated correlation to Scheimpflug corneal tomography. In most DMs a unique honeycomb collagen network was identified, with distinct bundles surrounding the guttae and correlating with expression of fibrillar collagens (1A1). Conversely, some DMs showed either reduced collagen on MPM and RT-qPCR analysis or diffuse thickening and storage of extracellular matrix. Conclusions The collagen structure of the DM and its adaptive remodeling in endothelial corneal dystrophies has been characterized for the first time here and will facilitate individual therapeutic approaches.
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Affiliation(s)
- Marcus Walckling
- Department of Ophthalmology, University Medicine Rostock, Rostock, Germany
| | - Rica Waterstradt
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Rostock, Rostock, Germany
| | - Simone Baltrusch
- Institute of Medical Biochemistry and Molecular Biology, University Medicine Rostock, Rostock, Germany.,Department Life, Light & Matter, University of Rostock, Rostock, Germany
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Hyperosmolar Eye Drops for Diurnal Corneal Edema in Fuchs' Endothelial Dystrophy: A Double-Masked, Randomized Controlled Trial. Ophthalmology 2021; 128:1527-1533. [PMID: 33892048 DOI: 10.1016/j.ophtha.2021.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Eye Drops for Early Morning-Associated Swelling (EDEMAS) trial assessed the efficacy of hyperosmolar eye drops on corneal edema resolution. DESIGN Double-masked, randomized controlled trial of hyperosmolar eye drops. PARTICIPANTS Participants with Fuchs' dystrophy scheduled for Descemet membrane endothelial keratoplasty. METHODS One eye was randomized to hyperosmolar eye drops (treatment); the fellow eye was randomized to artificial tears (placebo). After baseline examination in the afternoon, corneas were examined using Scheimpflug tomography after eye opening in the morning. Participants received eye drops twice. Imaging was repeated every 30 minutes up to 4 hours. MAIN OUTCOME MEASURES Decrease in central corneal thickness 1 hour after eye opening (primary end point), corneal thickness, subjective visual function, glare, visual acuity, and adverse events (AEs) (secondary end points). RESULTS A total of 68 participants received the allocated intervention (59 eyes received treatment; 55 eyes received placebo). All eyes had stromal edema; none had epithelial edema. Corneal thickness was 626 μm in the treatment arm and 622 μm in the placebo arm after eye opening, indicating an early morning edema compared with baseline of +21 μm and +24 μm, respectively. Decrease in corneal thickness after 1 hour was -10.5 μm in the treatment arm (95% confidence interval [CI], -12.8 to -8.2) and -11.2 μm (95% CI, -13.6 to -8.9) in the placebo arm (between-arm difference, 0.7 μm, 95% CI, -2.0 to 3.5; P = 0.59), indicating no clinically relevant effect of hyperosmolar eye drops on early morning corneal edema. Results were not compatible with a relevant treatment effect on corneal thickness, visual acuity, and glare over the entire course of the study. Increase in subjective visual function was less rapid in the treatment arm than in the placebo arm. Adverse events, most commonly burning after eye drop application, were more common with treatment (30 eyes) than placebo (1 eye; risk difference, 49 percentage points; 95% CI, 36-62). CONCLUSIONS In this double-masked, randomized controlled trial, resolution of early morning stromal edema was not accelerated by hyperosmolar eye drops, which more frequently caused AEs. These results are not compatible with a clinically relevant effect of hyperosmolar eye drops and do not support their routine use.
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Zander D, Grewing V, Glatz A, Lapp T, Maier PC, Reinhard T, Wacker K. Predicting Edema Resolution After Descemet Membrane Endothelial Keratoplasty for Fuchs Dystrophy Using Scheimpflug Tomography. JAMA Ophthalmol 2021; 139:423-430. [PMID: 33599696 DOI: 10.1001/jamaophthalmol.2020.6994] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Predicting the extent of corneal edema resolution after Descemet membrane endothelial keratoplasty (DMEK) may help in preoperative decision-making by identifying patients who may benefit from restoring endothelial function. Objective To develop and validate a predictive model for edema resolution after DMEK using Scheimpflug tomographic imaging. Design, Setting, and Participants Two prospective studies recruited participants with advanced Fuchs dystrophy at a university-based tertiary referral center between July 1, 2017, and August 31, 2019. Analyses were designed in November 2019 and completed on June 30, 2020. Development of a predictive model using linear least absolute shrinkage and selection operator regression was conducted in a derivation cohort (100 eyes). Overall performance, discrimination, and calibration were tested in the separate validation cohort (32 eyes). Exposures Preoperative Scheimpflug parameters and patient-reported visual disability were considered as potential predictors of edema resolution: (1) tomographic features (irregularity of lines of equal corneal thickness, displacement of the thinnest point of corneal thickness from the inferior-temporal quadrant, and absolute amount of focal posterior corneal depression), (2) standardized anterior and posterior corneal backscatter, (3) preoperative central corneal thickness, and (4) Fuchs dystrophy-specific visual disability. Main Outcomes and Measures Decrease in central corneal thickness after DMEK indicative of edema resolution. Results Of the 88 patients included in the analysis, 54 were women (61%); median age was 68 years (interquartile range [IQR], 59-76 years). A median of 13 months after DMEK (IQR, 9-16 months), median corneal thickness was 77 μm lower (IQR, 51-94 μm) in the derivation cohort and 75 μm lower in the validation cohort (IQR, 54-96 μm) than before surgery. Per 10-μm edema resolution, eyes gained 0.66 Early Treatment Diabetic Retinopathy Study letters (95% CI, 0.09-1.23) in best-corrected visual acuity. Three tomographic features were present in 68 of 100 eyes (68%) in the derivation cohort and in 18 of 32 eyes (56%) in the validation cohort before DMEK and in only 1 of 132 eyes (1%) after DMEK. To predict edema resolution after DMEK based on preoperative assessment, 5 variables were selected by the statistical learning algorithm: nonparallel isopachs, focal posterior depression, anterior and posterior corneal backscatter, and central corneal thickness. In the separate validation cohort, the model showed high overall performance, discrimination, and calibration. Conclusions and Relevance These post hoc analyses of prospective cohorts support a model for use in the prediction of edema resolution after DMEK using Scheimpflug measurement to identify patients benefitting most from DMEK.
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Affiliation(s)
- Daniel Zander
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viviane Grewing
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Glatz
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thabo Lapp
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philip C Maier
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Reinhard
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katrin Wacker
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Oie Y, Yasukura Y, Nishida N, Koh S, Kawasaki R, Maeda N, Jhanji V, Nishida K. Fourier Analysis on Regular and Irregular Astigmatism of Anterior and Posterior Corneal Surfaces in Fuchs Endothelial Corneal Dystrophy. Am J Ophthalmol 2021; 223:33-41. [PMID: 33039376 DOI: 10.1016/j.ajo.2020.09.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To conduct Fourier analysis on regular and irregular astigmatism of the anterior and posterior corneal surfaces using anterior segment optical coherence tomography in patients with Fuchs endothelial corneal dystrophy (FECD) DESIGN: Observational case series. METHODS This study included 75 eyes of 43 FECD patients and 34 eyes of 34 healthy subjects in Osaka University Hospital. Corneal dioptric data from the central 6-mm zone of the anterior and posterior corneal surface were expanded into spherical, regular astigmatism, asymmetry, and higher-order irregularity components using Fourier analysis. We analyzed the association between each component and modified Krachmer grade. RESULTS There were significant differences in regular astigmatism, asymmetry, and higher-order irregularity components of the anterior corneal surface, and spherical, regular astigmatism, asymmetry, and higher-order irregularity components of the posterior corneal surface among modified Krachmer grades (P = .036, <.001, <.001, <.001, <.001, <.001, and <.001, respectively). Asymmetry component of the anterior and posterior corneal surfaces gradually increased with FECD progression. Higher-order irregularity components of the anterior and posterior corneal surfaces drastically increased in Grade 6. Many eyes had an axis of 0°-180° for the asymmetry component of the anterior surface and 180°-360° for that of the posterior surface. CONCLUSION Patients with severe FECD had a larger amount of asymmetry and higher-order irregularity components of the anterior and posterior corneal surfaces. Patients with FECD up to Grade 5 were characterized by anterior and posterior flattening in the inferior cornea, and those with Grade 6 showed irregularity in the anterior and posterior corneal surfaces.
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Nowińska A, Chlasta-Twardzik E, Dembski M, Ulfik-Dembska K, Wylęgała E. Corneal Analysis with Swept Source Optical Coherence Tomography in Patients with Coexisting Cataract and Fuchs Endothelial Corneal Dystrophy. Diagnostics (Basel) 2021; 11:diagnostics11020223. [PMID: 33540847 DOI: 10.3390/diagnostics11020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
This study focused on defining the characteristic features of keratometry and pachymetry elevation maps based on swept source optical coherence tomography (SS OCT) in Fuchs endothelial corneal dystrophy (FECD) eyes with a coexisting cataract. 70 eyes of 35 patients diagnosed with FECD and a coexisting cataract and 70 control eyes were included in this prospective, controlled, observational, cross-sectional study. Features characteristic of intermediately affected eyes included an increased corneal thinnest thickness (CTT) (p = 0.01), 3 and 6 mm asymmetry (p < 0.0001), higher order Fourier indices (p < 0.05 and p ≤ 0.0001, respectively), chord µ, and a posterior Ectasia Screening Index (pESI) (p < 0.01). The lack of agreement between the anterior and posterior elevation map and a significant area of negative values in the posterior map were detected. In advanced FECD eyes, our study additionally revealed decreased posterior keratometry steep (Ks), keratometry flat (Kf), keratometry average (AvgK), eccentricity (Ecc), an increased corneal apex thickness (CAT), and decreased 3 and 6 mm posterior spherical indices (p < 0.0001 for all of the above). Characteristic features of subclinical FECD, independent of the corneal thickness, can be detected by SS OCT and should be considered during the preoperative assessment of patients with a coexisting cataract.
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Affiliation(s)
- Anna Nowińska
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
| | - Edyta Chlasta-Twardzik
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
| | - Michał Dembski
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
| | - Klaudia Ulfik-Dembska
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
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Wertheimer CM, Elhardt C, Wartak A, Luft N, Kassumeh S, Dirisamer M, Siedlecki J, Vounotrypidis E, Priglinger SG, Mayer WJ. Corneal optical density in Fuchs endothelial dystrophy determined by anterior segment optical coherence tomography. Eur J Ophthalmol 2020; 31:1771-1778. [PMID: 32700559 DOI: 10.1177/1120672120944796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE In this study, we propose a method to grade corneal stromal opacity using optical density measurements by anterior segment optical coherence tomography (AS-OCT) and validate the approach in Fuchs endothelial corneal dystrophy (FECD). METHODS A retrospective analysis of human corneal OCT scans was performed on 48 eyes of 32 patients with FECD and 33 control eyes of 21 patients using the Carl Zeiss Cirrus HD-OCT 5000. In addition, corneal edema in fresh rabbit cadaver eyes was artificially induced by distilled water and imaged with the Thorlabs TELESTO-II spectral domain OCT at different time points during saturation. The increase of opacity due to corneal edema was proposed to directly correlate with enhanced reflectivity sites in the OCT images, corresponding to higher optical density. The increase was determined as the image area above a statistically established gray-scale value using ImageJ and correlated with other disease characteristics. RESULTS Optical densities in human corneas showed significant differences between FECD patients and the control group (p = 0.002). The increased optical densities determined in FECD corneas correlated well with other disease characteristics such as corneal pachymetry or visual acuity. Likewise, rabbit corneas showed a time dependent increase in thickness and in corneal optical density during soaking in distilled water. CONCLUSION This study presents corneal optical density by AS-OCT as an objective value for corneal changes in FECD. Complementing other diagnostic tools in FECD the assessment of corneal optical density may identify progression of FECD, gauge novel therapeutic strategies and support risk and benefit analyses for corneal surgery.
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Affiliation(s)
| | - Carolin Elhardt
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Andreas Wartak
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nikolaus Luft
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Stefan Kassumeh
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Martin Dirisamer
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jakob Siedlecki
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | | | - Wolfgang J Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Schlereth SL, Hos D, Matthaei M, Hamrah P, Schmetterer L, O'Leary O, Ullmer C, Horstmann J, Bock F, Wacker K, Schröder H, Notara M, Haagdorens M, Nuijts RMMA, Dunker SL, Dickman MM, Fauser S, Scholl HPN, Wheeler-Schilling T, Cursiefen C. New Technologies in Clinical Trials in Corneal Diseases and Limbal Stem Cell Deficiency: Review from the European Vision Institute Special Interest Focus Group Meeting. Ophthalmic Res 2020; 64:145-167. [PMID: 32634808 DOI: 10.1159/000509954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
To discuss and evaluate new technologies for a better diagnosis of corneal diseases and limbal stem cell deficiency, the outcomes of a consensus process within the European Vision Institute (and of a workshop at the University of Cologne) are outlined. Various technologies are presented and analyzed for their potential clinical use also in defining new end points in clinical trials. The disease areas which are discussed comprise dry eye and ocular surface inflammation, imaging, and corneal neovascularization and corneal grafting/stem cell and cell transplantation. The unmet needs in the abovementioned disease areas are discussed, and realistically achievable new technologies for better diagnosis and use in clinical trials are outlined. To sum up, it can be said that there are several new technologies that can improve current diagnostics in the field of ophthalmology in the near future and will have impact on clinical trial end point design.
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Affiliation(s)
- Simona L Schlereth
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany, .,Center for Molecular Medicine (CMMC) University of Cologne, Cologne, Germany,
| | - Deniz Hos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine (CMMC) University of Cologne, Cologne, Germany
| | - Mario Matthaei
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Pedram Hamrah
- Cornea Service and Center for Translational Ocular Immunology, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore.,Institute for Health Technologies, Nanyang Technological University, Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Olivia O'Leary
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Christoph Ullmer
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Jens Horstmann
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Felix Bock
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Katrin Wacker
- Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Maria Notara
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michel Haagdorens
- Faculty of Medicine and Health Sciences, Department of Ophthalmology, Visual Optics and Visual Rehabilitation, University of Antwerp, Antwerp, Belgium.,Department of Ophthalmology, Antwerp University Hospital, Antwerp, Belgium
| | - Rudy M M A Nuijts
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Suryan L Dunker
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mor M Dickman
- University Eye Clinic, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sascha Fauser
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Wheeler-Schilling
- European Vision Institute EEIG, Brussels, Belgium.,Institute for Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine (CMMC) University of Cologne, Cologne, Germany
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Patel SV, Hodge DO, Treichel EJ, Spiegel MR, Baratz KH. Repeatability of Scheimpflug Tomography for Assessing Fuchs Endothelial Corneal Dystrophy. Am J Ophthalmol 2020; 215:91-103. [PMID: 32112772 DOI: 10.1016/j.ajo.2020.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine if agreement between subjective interpretations of Scheimpflug tomography maps of corneas with Fuchs endothelial corneal dystrophy (FECD) is affected by daily and hourly changes in corneal edema. DESIGN Reliability analysis. METHODS Scheimpflug imaging pachymetry and posterior elevation maps of corneas with a range of severity of FECD were evaluated in a randomized manner for the presence of 3 tomographic features of edema. Agreement between interpretations of 1 masked observer was assessed (percentage, and κ-statistic with 95% confidence interval) for images taken within minutes on the same day, for images taken at a similar time on a different day, and for images taken over the course of a morning. Intra- and interobserver agreement was also assessed. RESULTS Interpretations for individual tomographic features agreed for ≥88% of images (κ ≥ 0.75) taken within minutes on the same day; complete disagreement (ie, disagreement for all 3 tomographic features in an image) occurred in ≤3% of images. Interpretations agreed for ≥77% of images (κ ≥ 0.52) taken at a similar time on a different day; complete disagreement did not occur. Interpretations agreed for ≥81% of images (κ ≥ 0.61) taken over the course of a morning; complete disagreement occurred in ≤6% of images. Intraobserver agreement was ≥93% (κ ≥ 0.83) and interobserver agreement was ≥93% (κ ≥ 0.66); complete disagreement did not occur. CONCLUSIONS Subjective interpretation of Scheimpflug images in FECD is highly repeatable for disease classification. Although small variations in interpretations resulted from pathophysiologic changes in corneal hydration and other factors, clinically significant disagreements in interpretation were uncommon and therefore unlikely to affect clinical decision-making.
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Affiliation(s)
- Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Emily J Treichel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew R Spiegel
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Keith H Baratz
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Soh YQ, Kocaba V, Weiss JS, Jurkunas UV, Kinoshita S, Aldave AJ, Mehta JS. Corneal dystrophies. Nat Rev Dis Primers 2020; 6:46. [PMID: 32528047 DOI: 10.1038/s41572-020-0178-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 12/21/2022]
Abstract
Corneal dystrophies are broadly defined as inherited disorders that affect any layer of the cornea and are usually progressive, bilateral conditions that do not have systemic effects. The 2015 International Classification of Corneal Dystrophies classifies corneal dystrophies into four classes: epithelial and subepithelial dystrophies, epithelial-stromal TGFBI dystrophies, stromal dystrophies and endothelial dystrophies. Whereas some corneal dystrophies may result in few or mild symptoms and morbidity throughout a patient's lifetime, others may progress and eventually result in substantial visual and ocular disturbances that require medical or surgical intervention. Corneal transplantation, either with full-thickness or partial-thickness donor tissue, may be indicated for patients with advanced corneal dystrophies. Although corneal transplantation techniques have improved considerably over the past two decades, these surgeries are still associated with postoperative risks of disease recurrence, graft failure and other complications that may result in blindness. In addition, a global shortage of cadaveric corneal graft tissue critically limits accessibility to corneal transplantation in some parts of the world. Ongoing advances in gene therapy, regenerative therapy and cell augmentation therapy may eventually result in the development of alternative, novel treatments for corneal dystrophies, which may substantially improve the quality of life of patients with these disorders.
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Affiliation(s)
- Yu Qiang Soh
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore.,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Viridiana Kocaba
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands
| | - Jayne S Weiss
- Department of Ophthalmology, Pathology and Pharmacology, Louisiana State University, School of Medicine, New Orleans, USA
| | - Ula V Jurkunas
- Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Schepens Eye Research Institute, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Anthony J Aldave
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore. .,Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore. .,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore.
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Morphological and Optical Determinants of Visual Disability in Fuchs Endothelial Corneal Dystrophy. Cornea 2019; 39:726-731. [DOI: 10.1097/ico.0000000000002236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Preoperative Risk Assessment for Progression to Descemet Membrane Endothelial Keratoplasty Following Cataract Surgery in Fuchs Endothelial Corneal Dystrophy. Am J Ophthalmol 2019; 208:76-86. [PMID: 31369719 DOI: 10.1016/j.ajo.2019.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/14/2019] [Accepted: 07/20/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify preoperative corneal tomographic features that predict progression to endothelial keratoplasty (EK) following cataract surgery in Fuchs endothelial corneal dystrophy (FECD) and establish a regression model to identify high-risk patients. DESIGN Prospective, observational cohort study. METHODS Setting: Hospital Universitario Ramón y Cajal, Madrid, Spain. STUDY POPULATION Sixty-eight patients (84 eyes) with FECD who underwent phacoemulsification. INTERVENTION We assessed preoperative best-corrected visual acuity; ultrasound central corneal thickness; pachymetric, anterior chamber depth, and corneal backscatter variables using Scheimpflug imaging; and endothelial cell density. MAIN OUTCOME MEASURES Progression to EK. RESULTS A total of 33 eyes (39.3%) needed EK after phacoemulsification to rehabilitate vision. On multivariate analysis, anterior layer (AL) corneal backscatter between 0 and 2 mm from the apex and relative increase in central corneal thickness from the "relative pachymetry display" by the Pentacam were significant predictors of the risk of progression to EK. Using these 2 variables, a risk score (RISC score) was derived from the regression model (area under the curve = 0.973; best cutoff point with a specificity of 95% representing a sensitivity of 96%). Excluding corneal backscatter data from the multivariate regression model, corneal thickness at the pupil center by the Pentacam and relative increase in central corneal thickness were significant predictors and provided a modified risk score (RIPT score) with similar performance. CONCLUSION Both scores demonstrated accuracy in predicting progression to EK using easily accessible preoperative data. This approach, which can be readily implemented by surgeons, allows for individualized risk assessment.
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Zhang J, Patel DV, McGhee CNJ. The Rapid Transformation of Transplantation for Corneal Endothelial Diseases: An Evolution From Penetrating to Lamellar to Cellular Transplants. Asia Pac J Ophthalmol (Phila) 2019; 8:441-447. [PMID: 31789646 PMCID: PMC6903320 DOI: 10.1097/apo.0000000000000265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
The cornea is the major focusing structure of the human eye and the corneal endothelium maintains the relatively dehydrated state of the cornea required for clarity. The endothelial cells respond to disease or injury by migration and cellular enlargement. Our current understanding is that there is a very limited degree of proliferative or regenerative capacity in the human corneal endothelium. Thus, corneal endothelial diseases may result in corneal edema, significantly impact vision and quality of life. Contemporary surgical transplantation options for treating moderate to advanced endothelial dysfunction include penetrating keratoplasty (PK), Descemet stripping endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty. Advances in surgical techniques aim to bring faster visual recovery and improve visual outcomes; however, there is still a significant donor cornea shortage worldwide and alternative methods for treatment for corneal endothelial disease are rapidly evolving. Indeed, we are at a pivotal point in corneal transplantation for endothelial disease and novel surgical strategies include using 1 donor for multiple recipients, a minimally attached endothelial graft, and Descemet membrane stripping only. Crucially, forthcoming approaches include the use of Rho-Kinase (ROCK) inhibitors, endothelial cell therapy, tissue engineered grafts, and consideration of stem cell techniques. Ultimately, the choice of technique will be dependent on recipient factors such as age, type of endothelial disease, extent of the disease, and associated ocular disorders. The safety and efficacy of these rapidly developing treatments warrant further investigations. In time, some or all of these alternatives for corneal transplantation will alleviate the reliance on limited corneal donor tissue.
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Affiliation(s)
- Jie Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Fritz M, Grewing V, Maier P, Lapp T, Böhringer D, Reinhard T, Wacker K. Diurnal Variation in Corneal Edema in Fuchs Endothelial Corneal Dystrophy. Am J Ophthalmol 2019; 207:351-355. [PMID: 31415734 DOI: 10.1016/j.ajo.2019.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The extent of diurnal variation in corneal edema in Fuchs dystrophy is unknown. We measured corneal thickness and posterior profile over the course of the day using Scheimpflug imaging. DESIGN Prospective cohort study. METHODS Participants with clinically advanced Fuchs dystrophy eyes undergoing endothelial keratoplasty and participants with healthy corneas were assessed around noon the day before surgery and late afternoon, in presumed steady state. After controlled overnight patching to standardize eyelid closure, participants were assessed immediately upon eye opening in hospital the morning of surgery. RESULTS Directly upon awakening, patients had mean corneal thickness of 663 μm (interquartile range [IQR], 625-707) in Fuchs dystrophy (n = 44) and controls (n = 11) had thickness of 557 μm (IQR, 527-601). In control corneas, there were no systematic changes with time. In Fuchs dystrophy eyes, corneal thickness decreased after awakening. Ninety-five percent of patients can be expected to have a decrease in corneal thickness over the first 4 hours after awakening between 31 μm and 58 μm (95% prediction interval). Posterior Q decreased on average by 0.15 (95% confidence interval [CI], 0.07-0.23) and posterior radius of curvature decreased by 0.20 mm (95% CI, 0.14-0.27) over the first 4 hours, indicating that edema resolution steepened the central posterior cornea. Beyond 4 hours after awakening, corneas no longer changed considerably in Fuchs dystrophy. CONCLUSION Impaired hydration control in clinically advanced Fuchs dystrophy makes measurements of key corneal parameters unreliable directly after eye opening. Beyond the first hours after eye opening, corneal thickness measurements are unlikely to vary more in Fuchs dystrophy eyes than in normal eyes.
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Patel SV, Hodge DO, Treichel EJ, Spiegel MR, Baratz KH. Predicting the Prognosis of Fuchs Endothelial Corneal Dystrophy by Using Scheimpflug Tomography. Ophthalmology 2019; 127:315-323. [PMID: 31685256 DOI: 10.1016/j.ophtha.2019.09.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To determine if Scheimpflug tomography pachymetry map and posterior elevation map patterns, central corneal thickness (CCT), and corneal backscatter can predict the prognosis of Fuchs endothelial corneal dystrophy (FECD). DESIGN Cross-sectional study with follow-up of outcomes. PARTICIPANTS Ninety-six eyes (56 subjects) with a range of severity of FECD. METHODS Corneas were graded by cornea specialists according to the area and confluence of guttae and the presence of clinically definite edema. Masked and randomized Scheimpflug imaging pachymetry map and posterior elevation map patterns were assessed by 1 observer for loss of regular isopachs, displacement of the thinnest point of the cornea, and the presence of posterior surface depression. The prognosis of eyes over a 5-year (median) follow-up period was determined based on FECD progression (new onset of clinically definite edema or ≥5% increase in CCT) or intervention by endothelial keratoplasty. Cumulative probabilities of progression and intervention were estimated from survival analyses, with risk factors determined by using Cox proportional hazards models. MAIN OUTCOME MEASURES Pachymetry map and posterior elevation map patterns, corneal backscatter, and CCT (ultrasonic pachymetry). RESULTS In univariate analyses, loss of regular isopachs (hazard ratio [HR], 18.00) displacement of the thinnest point (HR, 11.53), focal posterior surface depression (HR, 10.21), and anterior corneal backscatter (HR, 1.22, per 1-grayscale unit increment), were risk factors for progression or intervention (P < 0.001), whereas CCT (HR, 1.30, per 25-μm increment) was not (P = 0.15). In multivariate analyses, loss of regular isopachs (HR, 11.57; P < 0.001) and displacement of the thinnest point (HR, 5.61; P = 0.02) were independent and clinically important risk factors for progression and intervention. The 5-year cumulative risk of disease progression and intervention was 7%, 48%, and 89% when none, 1 or 2, and all 3 pachymetry map and posterior elevation map parameters were present, respectively (P <0.001). The 4-year cumulative risk of disease progression and intervention after uncomplicated cataract surgery was 0%, 50%, and 75% when none, 1 or 2, and all 3 pachymetry map and posterior elevation map parameters were present, respectively (P < 0.001). CONCLUSIONS Three Scheimpflug tomography pachymetry map and posterior elevation map patterns can predict FECD prognosis independent of CCT. The risk of FECD progression and intervention, including after uncomplicated cataract surgery, increases according to the number of parameters present.
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Affiliation(s)
- Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | | | - Matthew R Spiegel
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Keith H Baratz
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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Wacker K, Reinhard T, Maier P. [Pathogenesis and diagnostic evaluation of Fuchs' endothelial corneal dystrophy]. Ophthalmologe 2019; 116:221-227. [PMID: 30402742 DOI: 10.1007/s00347-018-0799-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Following new treatment options for Fuchs' endothelial corneal dystrophy, our understanding of optical and structural changes in the patient's cornea is also starting to improve. OBJECTIVE To provide an update on clinical evaluation of Fuchs' dystrophy. MATERIAL AND METHODS Standardized approaches to evaluate patients with Fuchs dystrophy in routine practice and research are discussed, accounting for the progressive and partially irreversible structural changes in all corneal layers. RESULTS Early structural changes in the cornea can be detected before clinical edema becomes visible on slit-lamp exam. Optical limitations resulting from these structural changes can be quantified not only with high-contrast acuity but also with glare or contrast sensitivity tests. Characteristic vision-related limitations of patients with Fuchs dystrophy can, e.g., be assessed with V-FUCHS, a Fuchs dystrophy-specific "Visual Function and Corneal Health Status" instrument for patient-reported outcomes. CONCLUSION Clinical grading of Fuchs dystrophy in an edematous and a non-edematous stage is outdated. Better therapy options and our improved understanding of progressive changes in the entire cornea require a standardized assessment of optical and structural changes and patient-reported limitations.
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Affiliation(s)
- K Wacker
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - T Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - P Maier
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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Visual Function and Corneal Health Status (V-FUCHS) auf Deutsch: Ein Fragebogen spezifisch für Fuchs-Endotheldystrophie. Ophthalmologe 2019; 117:140-146. [DOI: 10.1007/s00347-019-0938-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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