Abstract
Purpose :
Guttae are small excrescences of Descemet’s membrane of the cornea that are characteristic in Fuchs endothelial dystrophy. Histopathology is the gold standard to detect guttae on Descemet’s membrane specimens. Guttae can be evaluated clinically by slit lamp examination and confocal or specular microscopy (SM). No prior studies have compared histology vs clinical imaging tools in the diagnosis of guttae. In this retrospective study, we examined Descemet's membranes from 39 patients with Fuchs endothelial dystrophy and characteristic guttae (by slit lamp or microscopy), that underwent keratoplasty.
Methods :
Descemet’s membrane specimens from 39 patients that underwent endothelial keratoplasty from 2020 to 2023 were submitted for histopathologic evaluation at our institution. Specimens were formalin fixed, paraffin-embedded, and multiple sections were stained with H&E. Sections were digitally scanned and microscopically evaluated for the presence or absence of guttae. Clinical records were reviewed for slit lamp and specular microscopy imaging reports.
Results :
Out of 39 patients with clinically diagnosed guttae, 12 showed no guttae on histologic examination of Descemet’s membrane. These 12 cases of non-guttae Fuchs endothelial dystrophy had guttae seen on slit lamp examination. Specular microscopy revealed guttae in 9 of these 12 cases, but 1 patient was negative by SM and positive on slit lamp, and 1 patient did not performed SM. Of the 27 patients with guttae present on histology, specular microscopy revealed guttae in 19, while image quality was too poor to grade in 6 patients and was not performed in 1 patient.
Conclusions :
We found that approximately 1/3 of clinically diagnosed guttae showed no guttae on histopathologic examination of Descemet’s membrane. We identified discrepancies in guttae diagnosis between slit lamp vs specular microscopy. Our findings support there is significant discrepancies between clinical and histologic identification of guttae. Since guttae are important for classification and prognosis of cornea dystrophies, histopathologic evaluation should be performed on all Descemet’s membrane specimens.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.