• Cornea/External Disease, Refractive Mgmt/Intervention

    Review of: Predicting the Prognosis of Fuchs Endothelial Corneal Dystrophy by Using Scheimpflug Tomography

    Patel S, Hodge D, Treichel E, et al. Ophthalmology, in press

    The authors of this prospective trial investigated whether Scheimpflug tomography could be used to predict the prognosis of Fuchs endothelial corneal dystrophy (FECD).

    Study design

    This cross-sectional study included 96 eyes (56 patients) diagnosed with FECD at the cornea service at Mayo Clinic. Eyes with other corneal pathologies, prior corneal surgery and prior intraocular surgery except cataract surgery (unless performed within the last month) were excluded. Each patient’s tomography by Pentacam HR was analyzed for several clinical indicators: loss of regular isopachs, displacement of the thinnest point of the cornea and focal posterior depression.

    Over a 5-year period, the prognosis of each eye was determined as based on FECD progression (new onset of clinically definite corneal edema, or an increase in CCT of at least 5% on 2 consecutive examinations) or as intervention with endothelial keratoplasty (EK).

    Outcomes

    During follow-up, 54 eyes did not show progression or need EK while the remaining 42 eyes did. The cumulative risk of disease progression or intervention over 5 years increased according to the number of tomographic indicators present: 7% when none present, 48% when 1 or 2 indicators were present and 89% when all 3 indicators were present. Of the eyes that underwent cataract surgery in the follow-up period, the 4-year risk of progression or intervention was 0% with no tomography indicators, 50% with 1 or 2 indicators and 75% with all 3 indicators.

    Limitations

    The study is limited by its small sample size. The threshold for intervention with EK wasn’t thoroughly explained.

    Clinical significance

    Ophthalmologists are often faced with stratifying risk of FECD progression, especially in determining when or if to proceed with laser refractive and cataract surgery. With more data, this study could point to an objective and simple way to guide patient counseling and the decision of when to proceed with cataract surgery and/or EK.