Corneal endothelium features in Fuchs’ Endothelial Corneal Dystrophy: A preliminary 3D anterior segment optical coherence tomography study

Abstract

PurposeTo evaluate the feasibility of 3D anterior segment optical coherence tomography (AS-OCT) for the detection of corneal endothelial features in patients with Fuchs’ Endothelial Corneal Dystrophy (FECD).MethodsTwenty patients with clinical diagnosis of FECD (group A), and 20 control subjects (group B) were enrolled. In all patients a complete ophthalmological examination was performed, including best corrected visual acuity (BCVA), slit lamp examination for subjective grading of FECD and corneal endothelial specular microscopy. A 512x128 AS-OCT cube centered on the corneal apex was performed, and then the inner surface of the cornea was visualized and analyzed individually.ResultsOverall, the study participants were adults (mean age was 57.35 ± 8.45 years [mean ± SD] 80% female) with a BCVA ranged from 1.3 to 0 LogMAR. The OCT analysis disclosed three different patterns of the corneal endothelium (1, 2, 3) according to the signal distribution and the level of reflectivity: a homogenous, hypo-reflective surface (pattern 1); the presence of hyper-reflective orange-yellowish points (pattern 2); and a mottled appearance with a variable number of hyper-reflective areas (pattern 3). The distributions of these morphological models in the two populations were as follows: patterns 1, 2 and 3 were observed respectively in 0%, 80%, and 20% of patients in group A, and in 80%, 20% and 0% of subjects in group B. Correlation analysis unveiled a positive relationship between OCT corneal endothelium reflectivity and the clinical severity score (assessed with biomicroscopy), as well as an inverse relationship between the OCT pattern and the integrity of corneal endothelium.Conclusion3D AS-OCT is a useful tool in investigation of endothelial features and therefore may represent a valuable support in the setting of FECD diagnosis and staging.

Changes in Corneal Epithelial Thickness Induced by Topical Antiglaucoma Medications

“…The anterior segment OCT imaging has attracted increasing attention because it is capable of indicating ultrastructural or functional changes of the ocular surface, which is useful for detecting corneal sublayer changes in various conditions such as keratoconus, laser refractive surgery, corneal crosslinking, orthokeratology, corneal dystrophies, and chemical burns [12,[23][24][25][26][27][28][29]. Corneal epithelial imaging via FD-OCT has recently become available and serves as a practical tool for in vivo epithelial mapping.…”

Fourier-Domain OCT Imaging of the Ocular Surface and Tear Film Dynamics: A Review of the State of the Art and an Integrative Model of the Tear Behavior during the Inter-Blink Period and Visual Fixation

“…Currently, OCT imaging is capable of identifying the anatomical structure and measuring the thickness of various corneal layers, and also of detecting some ultrastructural features (such as the stromal striae departing from the anterior stroma to the Descemet membrane) [7,63,64]. This approach can be useful in keratoconus eyes (where an increased epithelial thickness may be predictive of corneal hydrops) [65], in corneal dystrophies involving the epithelium and/or basal membrane [66], in differential diagnosis between pterygium and pseudo-pterygium [67], after photorefractive keratectomy [68] or cross-linking (during the remodeling of epithelium, and the detection of the demarcation line) [69], and in monitoring the epithelia changes following chemical burns [70].…”

Corneal Analysis with Swept Source Optical Coherence Tomography in Patients with Coexisting Cataract and Fuchs Endothelial Corneal Dystrophy

“…Other studies based on Fourier domain OCT have focused on visualization and assessment of the three-dimensional (3D) endothelium and Descemet’s membrane complex thickness (En-DMT) [ 15 , 23 , 38 ]. A recent OCT study revealed that 3D En-DMT has the highest sensitivity and specificity in diagnosing and grading FECD compared to the regional total corneal thickness (TCT) and central-to-peripheral total corneal (CPTR).…”

“…To precisely assess the corneal morphology with the relation to corneal layers at initial stages of FECD, it would be advisable to use ultra-high resolution or 3D anterior segment OCT, used by Shousha et al [ 15 ], Eleiva et al [ 23 ], or Iovino at al. [ 38 ] in their research, or to use confocal microscopy characterized by an axial resolution of 1 µm. The other reason for this is that, nowadays, we do not observe advanced, irreversible corneal changes in the course of the FECD in a clinical setting, because patients qualify for surgeries earlier in the disease course.…”