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Diagnostic Performance of 3-Dimensional Thickness of the Endothelium-Descemet Complex in Fuchs' Endothelial Cell Corneal Dystrophy.

Author information

Affiliations

  • 1. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Department of Ophthalmology, Faculty of Medicine, Benha University, Banha, Egypt.
      Authors
    • Eleiwa T 1
    (1 author)
  • 2. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Electrical and Computer Engineering, University of Miami, Miami, Florida.
      Authors
    • Elsawy A 2
    (1 author)
  • 3. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; International Medical Center, Egyptian Armed Forces, Cairo, Egypt.
      Authors
    • Tolba M 3
    (1 author)
  • 4. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
      Authors
    • Feuer W 4
    • Yoo S 4
    (2 authors)
  • 5. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Electrical and Computer Engineering, University of Miami, Miami, Florida; Department of Biomedical Engineering, University of Miami, Miami, Florida.
      Authors
    • Shousha MA 5
    (1 author)

ORCIDs linked to this article

Ophthalmology, 19 Jan 2020, 127(7):874-887
https://doi.org/10.1016/j.ophtha.2020.01.021 PMID: 32107067 

Abstract 

Purpose

To describe the diagnostic accuracy of 3-dimensional (3D) endothelium-Descemet's membrane complex thickness (En-DMT) in Fuchs' endothelial corneal dystrophy (FECD) and determine its potential role as an objective index of disease severity.

Design

Observational case-control study.

Participants

One hundred four eyes of 79 participants (64 eyes of 41 FECD patients and 40 eyes of 38 healthy controls).

Methods

All participants received high-definition OCT imaging (Envisu R2210; Bioptigen, Buffalo Grove, IL). Fuchs' endothelial corneal dystrophy was classified clinically into early-stage (without edema) and late-stage (with edema) disease. Automatic and manual segmentation of corneal layers was performed using a custom-built segmental tomography algorithm to generate 3D maps of total corneal thickness (TCT) and En-DMT of the central 6-mm cornea. Regional En-DMT, regional TCT, and central-to-peripheral total corneal thickness ratio (CPTR) were evaluated and correlated to the clinical severity of FECD. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to assess the reliability of the repeated measurements in all eyes.

Main outcome measures

Central-to-peripheral total corneal thickness ratio and average En-DMT and TCT of central, paracentral, and peripheral regions.

Results

In FECD, a significant increase in En-DMT, CPTR, and TCT was found compared to controls (P < 0.001). For identifying FECD, average En-DMT of paracentral and peripheral regions achieved 94% sensitivity and 100% specificity (cutoffs, 19 μm and 20 μm, respectively), whereas CPTR showed 94% sensitivity with a 73% specificity (cutoff, 0.97). Regarding early-stage FECD, average En-DMT of central zones achieved 92% sensitivity and 97% specificity (cutoff, 18 μm), whereas CPTR showed 90% sensitivity and 88% specificity (cutoff, 0.97). The average En-DMT of central, paracentral, and peripheral regions was correlated highly with FECD clinical stage (Spearman's ρ = 0.813, 0.793, and 0.721, respectively; all P < 0.001), compared with CPTR and mean TCT of paracentral zones (0.672 and 0.481, respectively; P < 0.001). The ICC values ranged from 0.98 (En-DMT) to 0.99 (TCT) with a good agreement between the automatic and manual measurements.

Conclusions

Regional 3D En-DMT is a novel diagnostic tool of FECD that can be used to quantify the disease severity with excellent reliability.

Full text links 

Read article at publisher's site: https://doi.org/10.1016/j.ophtha.2020.01.021

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Funding 

Funders who supported this work.

National Eye Institute

    National Institutes of Health (2)

    Research to Prevent Blindness

      University of Miami