Regional variability in corneal endothelial cell density between guttae and non-guttae areas in Fuchs endothelial corneal dystrophy

Imaging the Corneal Endothelium in Fuchs Corneal Endothelial Dystrophy

“…Both specular microscopy and confocal microscopy produce endothelial images easily in normal eyes without significant corneal scarring or edema, and no difference in ECD measured by either technique is observed. 26,30,31,[40][41][42][43][44][45] A prospective study by Salvetat and colleagues comparing confocal microscopy (HRT II RCM) and non-contact specular microscope (Tomey EM-3000) showed an overall good intermethod agreement in determining ECD in normal corneas. 31 Similarly, Kitzmann and colleagues compared confocal microscopy (ConfoScan 3) with non-contact specular microscopy (Konan) and showed no difference in ECD in normal patients when the ECDs were manually corrected.…”

“…26 Overall, these studies show that in normal patients and patients with early stage FECD with minimal corneal edema, central ECD as determined by either noncontact specular microscopy or confocal microscopy is highly correlated. 26,31,41,44,45 However, in cases of late FECD, where corneal edema prevents adequate specular imaging, confocal microscopy is superior to non-contact specular microscopy for imaging the CE and results in a larger percentage of high quality images of the CE. 20,26,45 In a study of 7 FECD eyes, specular microscopy was precluded in 1 eye due to significant corneal edema, while all 7 eyes were imaged with confocal microscopy.…”

“…26,31,41,44,45 However, in cases of late FECD, where corneal edema prevents adequate specular imaging, confocal microscopy is superior to non-contact specular microscopy for imaging the CE and results in a larger percentage of high quality images of the CE. 20,26,45 In a study of 7 FECD eyes, specular microscopy was precluded in 1 eye due to significant corneal edema, while all 7 eyes were imaged with confocal microscopy. 20 Similarly, in another study, specular microscopy was precluded in 7 eyes due to significant corneal edema, while all 11 eyes were imaged with confocal microscopy.…”

“…26 We have also recently demonstrated similar findings, where specular microscopy was precluded in 88 eyes out of 115 eyes with FECD, while all 115 eyes were imaged with confocal microscopy. 45 Furthermore, high quality specular images were captured in only 4 out 33 patients with late stage FECD. 45 FECD is a disease that typically first manifests as central corneal guttae followed by peripheral corneal involvement.…”

“…45 Furthermore, high quality specular images were captured in only 4 out 33 patients with late stage FECD. 45 FECD is a disease that typically first manifests as central corneal guttae followed by peripheral corneal involvement. 8 Furthermore, it has been demonstrated through non-contact specular microscopy (CEM-530) that there are regional differences in ECD between the central, paracentral and peripheral zones in FECD, where the CE is damaged more in the central zone than peripheral zones.…”