Subclinical corneal edema in FECD can be detected by Scheimpflug tomography. We recommend classifying FECD corneas as having clinically definite edema (based on slit-lamp examination), subclinical edema (based on tomographic features without clinically definite edema), or no edema (no tomographic or slit-lamp features of edema). This classification is independent of CCT and should be considered when evaluating FECD eyes for cataract surgery or EK.

Purpose Suboptimal visual acuity after endothelial keratoplasty has been attributed to increased anterior corneal high-order aberrations (HOAs). In this study, we determined anterior and posterior corneal HOAs over a range of severity of Fuchs endothelial corneal dystrophy (FECD). Design Cross-sectional study. Participants 108 eyes (62 subjects) with a range of severity of FECD and 71 normal eyes (38 subjects). Methods All corneas were examined by using slit-lamp biomicroscopy to determine the severity of FECD versus normality. FECD corneas were categorized as mild, moderate, or advanced according to the area and confluence of guttae and the presence of clinically visible edema. Normal corneas were devoid of any guttae. Wavefront errors from the anterior and posterior corneal surfaces were derived from Scheimpflug images and expressed as Zernike polynomials through the 6th order over a 6-mm-diameter optical zone. Backscatter from the anterior 120 μm and posterior 60 μm of the cornea were also measured from Scheimpflug images and were standardized to a fixed scatter source. Variables were compared between FECD and control eyes by using generalized estimating equation models to adjust for age and correlation between fellow eyes. Main Outcome Measures HOAs, expressed as root-mean-square of wavefront errors, and backscatter of the anterior and posterior cornea. Results Total anterior corneal HOAs were increased in moderate (0.61 ± 0.27 μm, mean ± standard deviation; p =0.01) and advanced (0.66 ± 0.28 μm; p =0.01) FECD compared to controls (0.47 ± 0.16 μm). Total posterior corneal HOAs were increased in mild (0.22 ± 0.09 μm; p =0.017), moderate (0.22 ± 0.08 μm; p <0.001), and advanced (0.23 ± 0.09 μm; p <0.001) FECD compared to controls (0.16 ± 0.03 μm). Anterior and posterior corneal backscatter were higher for all severities of FECD compared to controls (p ≤0.02, anterior; p ≤0.001, posterior). Conclusions Anterior and posterior corneal HOAs and backscatter are higher than normal even in early stages of FECD. The early onset of HOAs in FECD might contribute to the persistence of HOAs and incomplete visual rehabilitation after endothelial keratoplasty.

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