Impact of Fuchs Endothelial Corneal Dystrophy Severity on Scheimpflug-Derived Parameters After Descemet Membrane Endothelial Keratoplasty

Authors Stefanie Voncken Santana, Indrė Vasiliauskaitė, Korine van Dijk, Mirjam van Tilborg, Gerrit R.J. Melles, Viridiana Kocaba, Silke Oellerich
Published in Cornea - the Journal of Cornea and External Disease
Publication date 2022
Research groups Technology for Healthcare Innovations
Type Article


Purpose: The aim of this study was to evaluate how Scheimpflug-derived parameters of eyes with Fuchs endothelial corneal dystrophy (FECD) are influenced by Descemet membrane endothelial keratoplasty (DMEK) depending on FECD severity and the presence of subclinical edema. Methods: A retrospective cohort study including 115 eyes (115 patients) that underwent DMEK for FECD and a control group of 27 eyes with nonpathological corneas was conducted. Preoperative and 6 months postoperative Scheimpflug imaging was used to analyze pachymetry, presence of tomographic features (loss of isopachs/displacement of the thinnest point/focal posterior depression), and corneal backscatter. FECD severity was based on the modified Krachmer scale and the absence/presence of subclinical edema. Results: Scheimpflug-derived pachymetry, tomographic, and corneal backscatter parameters were correlated with FECD severity, and all changed from preoperatively to postoperatively (all P < 0.05). Postoperative central corneal thickness, anterior and posterior corneal backscatter, and presence of focal posterior depression remained different from the control group (all P < 0.05). Of eyes without preoperative clinical edema (n = 75), 18.7% showed 0 or 1 tomographic feature (no edema group) and 82.4% had 2 or 3 features (subclinical edema group). Compared with the control group, postoperative best-corrected visual acuity for the “no edema” group did not differ (0.03 ± 0.12 vs. −0.02 ± 0.08 logarithm of the minimum angle of resolution, P = 0.150) but was worse for the subclinical edema group (0.06 ± 0.08 vs. −0.02 ± 0.08 logarithm of the minimum angle of resolution, P = 0.001). Conclusions: For eyes without preoperative edema, more parameters reversed back to ‘normal’ levels than for eyes with (sub)clinical edema. Although most analyzed parameters correlated with FECD severity, corneal tomography might be best suited for objective grading of disease severity to aid in surgical decision-making.

On this publication contributed

Language English
Published in Cornea - the Journal of Cornea and External Disease
Key words DMEK, Krachmer scale, Fuchs endothelial corneal dystrophy severity, corneal backscatter, densitometry, pachymetry, Scheimpflug tomography, subclinical edema
Digital Object Identifier 10.1097/ICO.0000000000003115

Technology for Healthcare Innovations