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Daniel Repp, David Hodge, Keith Baratz, Jay McLaren, Katrina Kittleson, Sanjay Patel; Relationship between Central and Peripheral Corneal Thickness in Fuchs Endothelial Dystrophy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5989.
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To determine the relationship between central corneal thickness (CCT) and peripheral corneal thickness (PCT) in Fuchs endothelial dystrophy.
Corneal thickness was measured in 64 corneas of 52 patients with advanced Fuchs dystrophy (mean age, 67 years; range, 41-84 years), 25 corneas of 15 patients with mild Fuchs dystrophy (mean age, 68 years; range, 45-80 years) and 267 corneas of 142 normal subjects (mean age, 59 years; range, 24-88 years). Advanced Fuchs dystrophy was defined as corneas with ≥5 mm of central confluent guttae with or without stromal edema, and mild Fuchs dystrophy was defined as corneas with scattered non-confluent guttae or <5 mm of central confluent guttae and no clinically detectable edema. Normal corneas had no evidence of guttae. CCT was determined by ultrasonic (DGH 1000) pachometry, and PCT was determined by scanning-slit (Orbscan) pachometry as the mean thickness at 4 mm superior, inferior, nasal, and temporal to the center of the cornea. The central-to-peripheral-thickness-ratio (CPTR) was calculated by dividing CCT (by scanning-slit pachometry) by PCT at 4 mm. Correlations between age and CCT, PCT, and CPTR were assessed, and significances were determined by using generalized estimating equation (GEE) models to account for possible correlation between fellow eyes of the same subject. Comparisons between Fuchs dystrophy and normal were assessed by using GEE models. A receiver operator curve was generated to determine how well CPTR discriminated between Fuchs dystrophy and normal.
In normal corneas, CCT was not correlated with age (r= -0.10, p=0.28, n=267), whereas PCT decreased with age (r= -0.33, p<0.0001, n=254), and the CPTR increased with age (r= 0.59, p<0.0001, n=254). CCT was higher in Fuchs dystrophy (622 ± 61 μm, n=89) than normal (562 ± 30 μm, n=267, p<0.001), and PCT (adjusted for age) was higher in Fuchs dystrophy (652 ± 54 μm, n=80) than normal (643 ± 43 μm, n=254, p=0.003). The CPTR (adjusted for age) was higher in advanced Fuchs dystrophy (1.03 ± 0.07, n=56) than in mild Fuchs dystrophy (0.95 ± 0.07, n=24, p<0.001), and higher in mild Fuchs dystrophy than normal (0.87 ± 0.05, n=254 p<0.001). The CPTR was an important discriminator between Fuchs dystrophy (advanced and mild groups combined) and normal (area under the receiver operator curve, 0.94).
In Fuchs dystrophy, PCT is similar to normal and CCT is higher than normal, suggesting more corneal edema centrally, which corresponds to the typically central location of guttae. Consequently, the CPTR is greater in corneas with Fuchs dystrophy and correlates with disease severity. The CPTR might be an objective metric to determine severity of Fuchs dystrophy and monitor disease progression.
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