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Y. Ahuja, J. W. McLaren, K. H. Baratz, W. M. Bourne, S. V. Patel; Corneal Sensitivity and Nerves Before and After Keratoplasty for Fuchs' Dystrophy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):783.
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To determine changes in corneal sensitivity and nerves after three keratoplasty procedures for Fuchs’ endothelial dystrophy.
Seventy-one eyes of 64 patients with Fuchs’ dystrophy were prospectively examined by using a Cochet-Bonnet esthesiometer before and at intervals after three types of keratoplasty: Descemet-stripping endothelial keratoplasty (DSEK) with a 5-6 mm limbal incision (n=47), deep lamellar endothelial keratoplasty (DLEK) with a 9-10 mm limbal incision (n=11), or penetrating keratoplasty (PK) with a 7.5-7.75 mm recipient diameter (n=13). Cochet-Bonnet filament lengths ranged from 6 cm to 0.5 cm, which corresponded to pressures that ranged from 0.4 g/mm2 to ≥16 g/mm2. Postoperative sensitivities were compared to preoperative by using generalized estimating equation models to account for possible correlation between fellow eyes of the same subject; p-values were adjusted for multiple comparisons. Subbasal and stromal nerves were qualitatively assessed by confocal microscopy.
Preoperatively, sensitivity of Fuchs’ corneas did not differ between treatment groups (DSEK, 1.1 ± 1.6 g/mm2; DLEK, 1.1 ± 0.9 g/mm2; PK, 0.8 ± 0.4 g/mm2; p≥0.23). Sensitivity was decreased at 1 month after DSEK (4.2 ± 4.6 g/mm2; p<0.001), DLEK (7.2 ± 4.8 g/mm2; p<0.001), and PK (no detectable sensation in all eyes, p<0.001); the decrease was greater after DLEK than after DSEK (p=0.02). After DSEK, sensitivity remained decreased at 1 year (2.7 ± 3.7 g/mm2; p=0.02) but returned to preoperative by 2 years (1.1 ± 0.8 g/mm2; p=0.99). After DLEK, sensitivity remained decreased at 3 months (6.1 ± 4.8 g/mm2; p<0.001) and did not differ from preoperative at 6 months (3.7 ± 4.1 g/mm2; minimum detectable difference was 5.2 g/mm2, α=0.05/6, β=0.20, n=11). After PK, sensitivity did not return to preoperative by 3 years (8.8 ± 4.6 g/mm2; p<0.001). Subbasal nerves were not visible in 26 eyes (37%) preoperatively because of anterior corneal haze. Stromal nerves were tortuous in 11 eyes (15%) preoperatively and this abnormal morphology persisted in some eyes after endothelial keratoplasty.
Corneal sensitivity in Fuchs’ dystrophy is lower than we previously found in normal eyes. Corneal sensitivity loss is lower, and recovery is faster, after keratoplasty with smaller incisions. In a third of Fuchs’ dystrophy corneas subbasal nerves cannot be assessed by confocal microscopy because of anterior corneal haze. Abnormally tortuous stromal nerves are present in 15% of eyes with Fuchs’ dystrophy that require keratoplasty.
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