Scheimpflug Backscatter Imaging of the Fibrillar Layer in Fuchs Endothelial Corneal Dystrophy

Hribek, Agathe; Mestanoğlu, Mert; Clahsen, Thomas; Reinking, Niklas; Frentzen, Falk; Howaldt, Antonia; Siebelmann, Sebastian; Bachmann, Björn; Cursiefen, Claus; Matthaei, Mario

doi:10.1016/j.ajo.2021.08.019

Cited by 3 publications

(11 citation statements)

References 28 publications

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“…Slit-lamp biomicroscopy with confirmation of FECD diagnosis and modified Krachmer grading was performed by one of four corneal specialists (OO, CC, BB, MMa): Grade 1: 1–12 non-confluent central guttae; Grade 2: >12 non-confluent central guttae; Grade 3: confluent guttae over 1–2 mm in diameter; Grade 4: confluent guttae over 2–5 mm in diameter; Grade 5: >5 mm diameter confluent guttae; Grade 6: >5 mm diameter confluent guttae and corneal edema [ 8 , 11 ]. Scheimpflug imaging (Pentacam, Oculus GmbH) was performed as part of the routine diagnostic workup, including en face Scheimpflug backscatter analysis (Densitometry display, Pentacam software version 1.22r09) and Scheimpflug pachymetry analysis (Pachymetry display, Pentacam software version 1.22r09) [ 10 ]. Because previous studies have demonstrated the diurnal dependence of pachymetry values in advanced FECD [ 3 , 12 ], the time of day of Pentacam imaging was recorded as AM or PM.…”

Section: Methodsmentioning

confidence: 99%

“…Scheimpflug imaging data were analyzed by a single cornea specialist (OO) following instruction and joint grading of a pilot series with another experienced grader and cornea specialist (MMa). In the Densitometry display (Pentacam software version 1.22r09), the en face Scheimpflug backscatter plane with the highest backscatter gray scale unit (GSU) at the corneal apex within the posterior corneal 100 µm was selected as described before [ 10 ]. The image was exported in high-resolution quality.…”

Section: Methodsmentioning

confidence: 99%

“…Concentric annuli around the corneal apex superimposed by the Pentacam software served as a metric scale reference ( Figure 1 ). The presence of an FL was defined as a central or paracentral geographic hyperreflectivity with a maximum caliper diameter >1 mm [ 10 ]. The boundaries of the FL were manually marked using an image analysis software (ImageJ Version 1.53e, NIH, USA, Figure 1 ), and the FL area was calculated [ 13 , 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…In this context, our previous studies demonstrated by correlation of FECD histology and clinical imaging that collagen-rich deposits form as a fibrillar layer (FL) between the central endothelium and guttae of Descemet’s membrane in approximately 80% of advanced FECD eyes [ 9 , 10 ]. This FL represents a significant source of corneal backscatter and may be visualized by en face Scheimpflug backscatter imaging in vivo.…”

Section: Introductionmentioning

confidence: 99%

“…This FL represents a significant source of corneal backscatter and may be visualized by en face Scheimpflug backscatter imaging in vivo. Moreover, it was shown that the FL marks areas of significant decrease in corneal endothelial cell (CEC) density [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Correlation of Clinical Fibrillar Layer Detection and Corneal Thickness in Advanced Fuchs Endothelial Corneal Dystrophy

Özer

Mestanoğlu

Howaldt

et al. 2022

JCM

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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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Correlation of Clinical Fibrillar Layer Detection and Corneal Thickness in Advanced Fuchs Endothelial Corneal Dystrophy

Özer

Mestanoğlu

Howaldt

et al. 2022

JCM

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The novel role of lymphatic vessels in the pathogenesis of ocular diseases

Clahsen

Hadrian

Notara

et al. 2023

Progress in Retinal and Eye Research

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Separate Detection of Stromal and Epithelial Corneal Edema on Optical Coherence Tomography Using a Deep Learning Pipeline and Transfer Learning

et al. 2021

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The accurate detection of corneal edema has become a topic of growing interest with the generalization of endothelial keratoplasty. Despite recent advances in deep learning for corneal edema detection, the problem of minimal edema remains challenging. Using transfer learning and a limited training set of 11 images, we built a model to segment the corneal epithelium, which is part of a three-model pipeline to detect corneal edema. A second and a third model are used to detect edema on the stroma alone and on the epithelium. A validation set of 233 images from 30 patients consisting of three groups (Normal, Minimal Edema and important Edema) was used to compare the results of our new pipeline to our previous model. The mean edema fraction (EF), defined as the number of pixels detected as edema divided by the total number of pixels of the cornea, was calculated for each image. With our previous model, the mean EF was not statistically different between the Normal and Minimal Edema groups (p = 0.24). With the current pipeline, the mean EF was higher in the Minimal Edema group compared to the Normal group (p < 0.01). The described pipeline constitutes an adjustable framework for the detection of corneal edema based on optical coherence tomography and yields better performances in cases of minimal or localized edema.

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Scheimpflug Backscatter Imaging of the Fibrillar Layer in Fuchs Endothelial Corneal Dystrophy

Cited by 3 publications

References 28 publications

Correlation of Clinical Fibrillar Layer Detection and Corneal Thickness in Advanced Fuchs Endothelial Corneal Dystrophy

Correlation of Clinical Fibrillar Layer Detection and Corneal Thickness in Advanced Fuchs Endothelial Corneal Dystrophy

The novel role of lymphatic vessels in the pathogenesis of ocular diseases

Separate Detection of Stromal and Epithelial Corneal Edema on Optical Coherence Tomography Using a Deep Learning Pipeline and Transfer Learning

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