Abstract
Purpose :
The recognition of subclinical edema in Fuchs Endothelial Corneal Dystrophy (FECD) has important clinical implications: objective treatment-oriented stratification of disease, tracking progression & prognostication. While tomographic features have been identified to define subclinical edema, their morphological & visual correlates have not been studied in detail. Our aim is to study the morphological & visual correlates of subclinical edema in FECD prospectively.
Methods :
The eyes with clinical FECD (Cases) were compared with age-matched normals (Controls). Eyes with clinically significant cataract, corneal scars, corneal surgery, retinal pathology were excluded from both groups. Comprehensive ocular examination including corrected distance visual acuity(CDVA), contrast sensitivity function(CSF) with & without glare(CSV-1000), retinal straylight (C-Quant), anterior segment OCT(Cirrus, Zeiss) for central corneal thickness(CCT), center-to-periphery pachymetry ratio(CPR), epithelial thickness, Scheimpflug imaging(Pentacam HR) for refractive quad-map, corneal higher order aberrations(HOA)were done. Cases were stratified based on modified Krachmer grading (1-6) and sub-classified as “No edema” (Group A), “Subclinical edema”(Group B), based on having any 2 of the 3 tomographic features(loss of isopachs, displacement of thinnest point, focal posterior depression) and “Clinical edema”(Krachmer grade 6). Kruskal Wallis test was used to compare controls with each of the subgroups of cases, using morphological and visual parameters. P value <0.05 was considered statistically significant.
Results :
Sixty five eyes with FECD (Group A,B,C having 24, 27 & 14 eyes respectively) were compared with 72 controls. CDVA, CSF & Straylight were significantly worse in Groups A,B,C compared to Controls. CDVA, CCT, CPR & HOA were worse in Groups B,C compared to Group A & Controls. Across all groups, there was a progressive change in CDVA,CSF,Pachymetry, CPR, epithelial thickness & HOA. Fig 1 a&b show the visual correlates and Fig 1 c&d show the morphological correlates that were significantly different in the 4 groups.
Conclusions :
Morphological correlates of subclinical edema include Pachymetry, CPR. Visual correlates include CDVA & HOA.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.