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Suzuki T, Yamaguchi T, Yagi-Yaguchi Y, Kasamatsu H, Tomida D, Fukui M, Shimazaki J. Three-Dimensional Assessment of Descemet Membrane Reflectivity by Optical Coherence Tomography in Fuchs Endothelial Corneal Dystrophy. Cornea 2024; 43:207-213. [PMID: 37506375 DOI: 10.1097/ico.0000000000003356] [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: 01/14/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE This study aimed to evaluate Descemet membrane reflectivity using anterior segment optical coherence tomography (AS-OCT) in eyes with Fuchs endothelial corneal dystrophy (FECD). METHODS We retrospectively assessed 144 eyes of 88 consecutive participants (41 FECD, 15 pseudophakic bullous keratopathies [BKs], and 32 healthy controls, 63.5 ± 16.5 years). FECD was graded 0 to 3 based on the guttae areas using specular microscopy. The sum of AS-OCT reflectivity of the 3-dimensional volume from 10 μm thickness from the endothelial surface of the cornea and residual stromal area was calculated as D sum (endo) and D sum (stroma) in the central area of 3- and 6-mm diameters, respectively. The D ES ratio was defined as the ratio of D sum (endo) to D sum (stroma). The percentage of the guttae area in the specular images was calculated using MATLAB. D sum (endo) and D ES ratio were compared among FECD, BK, and healthy controls. RESULTS D sum (endo) in FECD grade 3 was significantly higher than that in healthy control eyes, FECD patients with mild and moderate guttae, and BK (all P ≤ 0.040). The D ES ratio in FECD patients with mild to severe guttae (grade 1-3) was significantly higher than that in healthy control eyes and BK (all P ≤ 0.035). The percentage of the guttae area was significantly correlated with D sum (endo) (R = 0.488, P < 0.001 for 3 mm, R = 0.512, P < 0.001 for 6 mm) and D ES ratio (R = 0.450, P < 0.001 for 3 mm, R = 0.588, P < 0.001 for 6 mm). CONCLUSIONS Descemet membrane reflectivity in AS-OCT can be objective biomarkers for assessing guttae and FECD severity from early to end-stage FECD.
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Affiliation(s)
- Takanori Suzuki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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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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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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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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Ademmer V, Agha B, Shajari M, Kohnen T, Schmack I. Impact of DMEK on visual quality in patients with Fuchs' endothelial dystrophy. Graefes Arch Clin Exp Ophthalmol 2022; 260:521-528. [PMID: 34529133 PMCID: PMC8786756 DOI: 10.1007/s00417-021-05334-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate short-term (3 months follow-up) changes in visual quality following Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy (FED). METHODS In this prospective institutional case series, 51 patients that underwent DMEK for FED were included. Assessment included the Quality of Vision (QoV) questionnaire preoperatively, at 1 month, and 3 months after surgery. Secondary outcome measures were anterior segment parameters acquired by Scheimpflug imaging, corrected distance visual acuity (CDVA), and endothelial cell density (ECD). RESULTS Glare, hazy vision, blurred vision, and daily fluctuation in vision were the symptoms mostly reported preoperatively. All symptoms demonstrated a significant reduction of item scores for severity, frequency, and bothersome in the course after DMEK (P < 0.01). Glare and fluctuation in vision remained to some extent during the follow-up period (median score = 1). Preoperatively, corneal densitometry correlated moderately to weakly with severity of hazy vision (rs = 0.39; P = 0.03) and frequency (rs = 0.26; P = 0.02) as well as severity (rs = 0.27; P = 0.03) of blurry vision. CDVA and central corneal thickness (CCT) did not correlate with visual complains. CONCLUSIONS Following DMEK for FED, patient-reported visual symptoms assessed by the QoV questionnaire represent a useful tool providing valuable information on the impact of DMEK on visual quality that cannot be directly estimated by morphological parameters and visual acuity only.
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Affiliation(s)
- Vanessa Ademmer
- grid.7839.50000 0004 1936 9721Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Bishr Agha
- grid.7839.50000 0004 1936 9721Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Mehdi Shajari
- grid.7839.50000 0004 1936 9721Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany ,grid.5252.00000 0004 1936 973XDepartment of Ophthalmology, LMU, Mathildenstraße 8, 80336 Munich, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Ingo Schmack
- grid.7839.50000 0004 1936 9721Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Gupta PK, Berdahl JP, Chan CC, Rocha KM, Yeu E, Ayres B, Farid M, Lee WB, Beckman KA, Kim T, Holland EJ, Mah FS. The corneal endothelium: clinical review of endothelial cell health and function. J Cataract Refract Surg 2021; 47:1218-1226. [PMID: 34468459 DOI: 10.1097/j.jcrs.0000000000000650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/19/2021] [Indexed: 12/17/2022]
Abstract
The endothelial cell is a critical structure within the cornea and is responsible for maintaining corneal clarity through its pump function. Endothelial cells are lost over time naturally but can be injured medically, surgically, or as a part of various dystrophies. Monitoring of endothelial cells can be performed clinically or more formally with specular microscopy. In cases of significant compromise, endothelial cells can be transplanted by various endothelial keratoplasty techniques. The future pipeline is bright for possible endothelial cell regeneration and rehabilitation. This article reviews these topics in depth to provide a comprehensive look at the structure and function of the endothelial cell, etiologies of endothelial cell damage, detailed review of iatrogenic causes of endothelial cell loss, and management strategies.
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Affiliation(s)
- Preeya K Gupta
- From the Department of Ophthalmology, Duke Eye Center, Durham, North Carolina (Gupta, Kim); Vance Thompson Vision, Sioux Falls, South Dakota (Berdahl); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Chan); Medical University of South Carolina, Storm Eye Institute, Charleston, South Carolina (Rocha); Virginia Eye Consultants, Norfolk, Virginia (Yeu); Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania (Ayres); Gavin Herbert Eye Institute, University of California-Irvine, Irvine, California (Farid); Eye Consultants of Atlanta and Georgia Eye Bank, Atlanta, Georgia (Lee); Comprehensive EyeCare of Central Ohio, Westerville, Ohio (Beckman); Department of Ophthalmology, The Ohio State University, Columbus, Ohio (Beckman); Cincinnati Eye Institute and the University of Cincinnati, Cincinnati, Ohio (Holland); Scripps Clinic Medical Group, La Jolla, California (Mah)
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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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