Purpose
Suboptimal visual acuity after endothelial keratoplasty has been attributed to increased
anterior corneal high-order aberrations (HOAs). In this study, we determined anterior
and posterior corneal HOAs over a range of severity of Fuchs' endothelial corneal
dystrophy (FECD).
Design
Cross-sectional study.
Participants
A total of 108 eyes (62 subjects) with a range of severity of FECD and 71 normal eyes
(38 subjects).
Methods
All corneas were examined by using slit-lamp biomicroscopy to determine the severity
of FECD versus normality. Fuchs' endothelial corneal dystrophy corneas were categorized
as mild, moderate, or advanced according to the area and confluence of guttae and
the presence of clinically visible edema. Normal corneas were devoid of any guttae.
Wavefront errors from the anterior and posterior corneal surfaces were derived from
Scheimpflug images and expressed as Zernike polynomials through the sixth order over
a 6-mm diameter optical zone. Backscatter from the anterior 120 μm and posterior 60
μm of the cornea also was measured from Scheimpflug images and was standardized to
a fixed scatter source. Variables were compared between FECD and control eyes by using
generalized estimating equation models to adjust for age and correlation between fellow
eyes.
Main Outcome Measures
High-order aberrations, expressed as root mean square of wavefront errors, and backscatter
of the anterior and posterior cornea.
Results
Total anterior corneal HOAs were increased in moderate (0.61±0.27 μm, mean ± standard
deviation;
P = 0.01) and advanced (0.66±0.28 μm;
P = 0.01) FECD compared with controls (0.47±0.16 μm). Total posterior corneal HOAs
were increased in mild (0.22±0.09 μm;
P = 0.017), moderate (0.22±0.08 μm;
P < 0.001), and advanced (0.23±0.09 μm;
P < 0.001) FECD compared with controls (0.16±0.03 μm). Anterior and posterior corneal
backscatter were higher for all severities of FECD compared with controls (
P ≤ 0.02, anterior;
P ≤ 0.001, posterior).
Conclusions
Anterior and posterior corneal HOAs and backscatter are higher than normal even in
early stages of FECD. The early onset of HOAs in FECD might contribute to the persistence
of HOAs and incomplete visual rehabilitation after endothelial keratoplasty.
Abbreviations and Acronyms:
CCT ( central corneal thickness), CI ( confidence interval), ECDe ( effective endothelial cell density), FECD ( Fuchs' endothelial corneal dystrophy), GEE ( generalized estimating equation), HOA ( high-order aberration), SU ( scatter units)To read this article in full you will need to make a payment
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References
- Fuchs' dystrophy.Cornea. 1988; 7: 2-18
Eye Bank Association of America. 2013 Eye Banking Statistical Report. Available at: http://www.restoresight.org/wp-content/uploads/2014/04/2013_Statistical_Report-FINAL.pdf 2014. Accessed February 25, 2015.
- Three-year visual acuity outcomes after Descemet's stripping automated endothelial keratoplasty.Ophthalmology. 2012; 119: 1126-1129
- Clinical outcome of 500 consecutive cases undergoing Descemet's membrane endothelial keratoplasty.Ophthalmology. 2015; 122: 464-470
- Anterior corneal aberrations after Descemet stripping endothelial keratoplasty for Fuchs endothelial dystrophy.Ophthalmology. 2012; 119: 1522-1529
- Potential causes of incomplete visual rehabilitation at 6 months postoperative after Descemet membrane endothelial keratoplasty.Am J Ophthalmol. 2013; 156: 780-788
- Incidence of irregular astigmatism eligible for contact lens fitting after Descemet membrane endothelial keratoplasty.J Cataract Refract Surg. 2013; 39: 1036-1046
- Corneal higher-order aberrations after Descemet's membrane endothelial keratoplasty.Ophthalmology. 2012; 119: 528-535
- Characteristic higher-order aberrations of the anterior and posterior corneal surfaces in 3 corneal transplantation techniques.Am J Ophthalmol. 2012; 153: 284-290
- Effect of anterior and posterior corneal surface irregularity on vision after Descemet-stripping endothelial keratoplasty.J Cataract Refract Surg. 2009; 35: 688-694
- In vivo confocal microscopy of Fuchs endothelial dystrophy before and after endothelial keratoplasty.JAMA Ophthalmol. 2013; 131: 611-618
- Corneal abnormalities early in the course of Fuchs' endothelial dystrophy.Ophthalmology. 2014; 121: 2325-2333
- Corneal haze determined by confocal microscopy two years after Descemet stripping with endothelial keratoplasty for Fuchs corneal dystrophy.Arch Ophthalmol. 2012; 130: 868-874
- Objective assessment of the corneal endothelium in Fuchs' endothelial dystrophy.Invest Ophthalmol Vis Sci. 2014; 55: 1184-1190
- A multicenter study to map genes for Fuchs endothelial corneal dystrophy: baseline characteristics and heritability.Cornea. 2012; 31: 26-35
- Fuchs' endothelial corneal dystrophy. Subjective grading versus objective grading based on the central-to-peripheral thickness ratio.Ophthalmology. 2013; 120: 687-694
- Central cornea guttata. Incidence in the general population.Am J Ophthalmol. 1967; 64: 1155-1158
- Corneal aberrations and visual acuity after laser in situ keratomileusis: femtosecond laser versus mechanical microkeratome.Am J Ophthalmol. 2010; 149: 785-793
- Measuring corneal thickness with the ConfoScan 4 and Z-ring adapter.Eye Contact Lens. 2007; 33: 185-190
- Standardization of corneal haze measurement in confocal microscopy.Invest Ophthalmol Vis Sci. 2010; 51: 5610-5616
- Normative database for corneal backscatter analysis by in vivo confocal microscopy.Invest Ophthalmol Vis Sci. 2011; 52: 7274-7281
- Longitudinal data analysis for discrete and continuous outcomes.Biometrics. 1986; 42: 121-130
- Optical aberrations of the human cornea as a function of age.J Opt Soc Am A Opt Image Sci Vis. 2000; 17: 1697-1702
- Normative values for corneal densitometry analysis by Scheimpflug optical assessment.Invest Ophthalmol Vis Sci. 2014; 55: 162-168
- Corneal wavefront errors 24 months after deep lamellar endothelial keratoplasty and penetrating keratoplasty.Am J Ophthalmol. 2009; 147: 959-965
- Retinal point-spread function after corneal transplantation for Fuchs' dystrophy.Invest Ophthalmol Vis Sci. 2011; 52: 1003-1008
- The effect of corneal light scatter on vision after Descemet stripping with endothelial keratoplasty.Arch Ophthalmol. 2009; 127: 153-160
- Anterior keratocyte depletion in Fuchs endothelial dystrophy.Arch Ophthalmol. 2011; 129: 555-561
- Decreased corneal sensitivity and abnormal corneal nerves in Fuchs endothelial dystrophy.Cornea. 2012; 31: 1257-1263
- The specific architecture of the anterior stroma accounts for maintenance of corneal curvature.Br J Ophthalmol. 2001; 85: 437-443
- 3-D characterization of the corneal shape in Fuchs dystrophy and pseudophakic keratopathy.Invest Ophthalmol Vis Sci. 2011; 52: 206-214
- Pentacam characterization of corneas with Fuchs dystrophy treated with Descemet membrane endothelial keratoplasty.J Refract Surg. 2010; 26: 972-979
- Fuchs' endothelial dystrophy of the cornea.Surv Ophthalmol. 1993; 38: 149-168
- Repeat Descemet membrane endothelial keratoplasty after complicated primary Descemet membrane endothelial keratoplasty.Ophthalmology. 2015; 122: 8-16
- Changes in the refractive index of the stroma and its extrafibrillar matrix when the cornea swells.Biophys J. 2003; 85: 2205-2212
- Near complete visual recovery and refractive stability in modern corneal transplantation: Descemet membrane endothelial keratoplasty (DMEK).Cont Lens Anterior Eye. 2013; 36: 13-21
- Vision-related quality of life before and after keratoplasty for Fuchs' endothelial dystrophy.Ophthalmology. 2014; 121: 2147-2152
- Keratoplasty outcomes: are we making advances?.Ophthalmology. 2014; 121: 977-978
Article Info
Publication History
Published online: June 05, 2015
Accepted:
May 4,
2015
Received in revised form:
May 2,
2015
Received:
February 27,
2015
Footnotes
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by Research to Prevent Blindness , New York, New York (unrestricted grant to the Department of Ophthalmology and support (to S.V.P.) as Olga Keith Wiess Special Scholar); Dr. Werner Jackstaedt-Stiftung, Wuppertal, Germany (Research Fellowship to K.W.); Mayo Clinic Center for Translational Science Activities (grant no. UL1 TR000135 from the National Center for Advancing Translational Sciences , a component of the National Institutes of Health, Bethesda, MD); and Mayo Foundation , Rochester, Minnesota. The funding organizations had no role in the design or conduct of this research.
Author Contributions:
Conception and design: Wacker, McLaren, Amin, Baratz, Patel
Data collection: Wacker, Amin, Patel
Analysis and interpretation: Wacker, McLaren, Amin, Baratz, Patel
Obtained funding: Not applicable
Overall responsibility: Wacker, McLaren, Amin, Baratz, Patel
Identification
Copyright
© 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
