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L. M. Hoesl, W. A. Schrems, B. Shahatit, U. V. Jurkunas, P. Hamrah; Cellular and Subbasal Nerve Alterations in Fuchs’ Endothelial Dystrophy: An in vivo Confocal Microscopy Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3708.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze the morphology and density of corneal epithelial cells, keratocytes, and subbasal nerves in patients with Fuchs' Endothelial Dystrophy (FECD) by in vivo confocal microscopy (IVCM) as compared to corneal endothelial cell count (ECC) and central corneal thickness (CCT).
Retrospective analysis of IVCM scans of 53 corneas from 33 patients with FECD and 10 normal corneas was performed. IVCM of the central cornea had been performed using the Confoscan 4 (Nidek, Inc.). Two masked observers reviewed the images in regards to morphology and density of the superficial and basal epithelial cells, anterior and posterior stromal keratocytes, endothelial cells, as well as subbasal corneal nerves, including the total number of nerves, number of main nerve trunks, total length of nerves per image, branching pattern, and tortuosity. Central corneal thickness was measured in all patients and normals. Statistical correlations were evaluated by Pearson correlation coefficient.
Total corneal nerve length was significantly (p=0.013) reduced in patients with FECD (1676.25 µm) as compared to normals (2233.56 µm). Total nerve count, number of main nerve trunks, and branching were lower in FECD patients than in normal eyes, but did not reach statistical significance. The density and morphology of superficial (1586.7 vs. 1483.8 cells/mm², p=0.062) and basal epithelial cells (5664.7 vs. 5658.3 cells/mm², p=0.961), anterior keratocytes (874.7 vs. 880.9 cells/mm², p=0.585), and posterior keratocytes (593.5 vs. 610.5 cells/mm², p=0.036) did not show statistical significance between patients and controls respectively. Significant correlations were found between CCT and ECC, total number of nerves and total nerve length.
IVCM reveals a significant decrease in the total nerve length in FECD patients and suggest alterations in corneal innervation. Further studies need to investigate whether the reduced corneal nerve length is caused by corneal edema or from the actual decrease in ECC, appearing in FECD.
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