Association among basement membrane diseases of the eye: Fuchs endothelial corneal dystrophy (FECD), anterior basement membrane dystrophy (ABMD) and age-related macular degeneration (AMD)

Abstract

Purpose : The pathophysiologic processes in FECD, ABMD, and AMD all involve basement membrane dysfunction. We tested the hypothesis that FECD is independently associated with presence of ABMD and AMD.

Methods : This is a single-center cross-sectional study, approved by the University at Buffalo IRB. A single ophthalmologist for this study systematically examined consecutive patients for FECD, ABMD and AMD. We enrolled individuals >18 years old with documented exam findings for all three ocular diseases, and excluded those with bilateral corneal scarring (preventing full exam) and penetrating keratoplasty. FECD was graded (modified Krachmer scale) based on findings of central corneal guttae (0=absent to 6=confluent with corneal edema). Patients that had undergone endothelial keratoplasty were assigned FECD grade 7. Patients with characteristic map-dot fingerprint changes of the epithelium were considered ABMD positive. Patients with macular drusen, pigmentary changes, or atrophy of the retinal pigment epithelium were considered AMD positive. Those with sparse small drusen or absence of pigment abnormalities were considered AMD negative. Poisson regression with robust estimation was used to estimate crude and age-adjusted prevalence ratios and 95% confidence intervals of ABMD, AMD or both among participants with different severity levels of FECD compared to individuals with absent FECD (grade 0 used as reference group). Significance was set at p<0.05.

Results : Among 435 participants (ages 18-96, mean 61 years; 262 female, Table 1), the prevalence of having ABMD, AMD, or both, was greater in those with FECD grades of 3-5, 7, and ≥ 1 vs. 0 (Table 2). After age adjustment, we continued to find a statistically significant increased prevalence of ABMD, AMD or both among those with FECD grade 7 vs. 0 (Table 2).

Conclusions : Advanced FECD may be significantly associated with ABMD and AMD. However, these findings seem to be driven by associations in those who have undergone corneal transplantation, suggesting a role for corneal transplantation in the progression of ABMD and AMD.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.