Corneal Endothelial Pathologies Visualized Using Ultra-High Resolution Optical Coherence Tomography

Abstract

Purpose: : To evaluate various endothelial pathologies using ultra high resolution anterior segment optical coherence tomography (UHR-OCT).

Methods: : A custom built spectral domain UHR-OCT with 3µm resolution (UHR OCT) was used to image 33 patients with eight different endothelial pathologies. Twenty patients had Fuchs’ dystrophy, three had pseudophakic bullous keratopathy (PBK), three had failed penetrating keratoplasty (PK) grafts, one had history of herpetic endothelitis, one had endothelial scar post chemical eye injury, three had corneal endothelial precipitates, one had endothelial extension of a Radial Keratotomy (RK) cut and one had posterior polymorphous corneal dystrophy (PPMD).

Results: : In cases of Fuchs’ dystrophy, UHR OCT showed thickened Descemet’s membrane with suspended round formations and irregular posterior surface with abnormally thickened cornea. In PBK, Descemet’s membrane appeared as a normal-thickness smooth wavy double line with abnormally thick cornea that had fine translucent clefts in the stroma and epithelium. Rejected PK grafts showed normal-thickness Descemet’s membrane with round suspended formations and an abnormally thickened cornea. Endothelial scar post chemical eye injury showed a thick opaque band on the inner aspect of the Descemet’s membrane with a thick translucent cleft in the epithelial layer and absence of Bowman’s layer. Post herpetic endothelitis had the appearance of a wavy Descemet’s membrane, with hyper reflective posterior stroma and oval suspended bodies. Corneal endothelium precipitates appeared as round formations suspended from the endothelial side of the Descemet’s membrane. Post RK case showed a notch like defect in Descemet’s membrane with linear stromal scars. PPMD showed opaque bands on both surfaces of Descemet’s membrane with abnormally thickened cornea.

Keywords: cornea: endothelium • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • imaging/image analysis: clinical