Three-Dimensional Assessment of Descemet Membrane Reflectivity by Optical Coherence Tomography in Fuchs Endothelial Corneal Dystrophy

Purpose: This study aimed to evaluate Descemet membrane reflectivity using anterior segment optical coherence tomography (AS-OCT) in eyes with Fuchs endothelial corneal dystrophy (FECD).Methods: We retrospectively assessed 144 eyes of 88 consecutive participants (41 FECD, 15 pseudophakic bullous keratopathies [BKs], and 32 healthy controls, 63.5 +/- 16.5 years). FECD was graded 0 to 3 based on the guttae areas using specular microscopy. The sum of AS-OCT reflectivity of the 3-dimensional volume from 10 mu m thickness from the endothelial surface of the cornea and residual stromal area was calculated as D-sum(endo) and D-sum(stroma) in the central area of 3- and 6-mm diameters, respectively. The D-ES ratio was defined as the ratio of D-sum(endo) to D-sum(stroma). The percentage of the guttae area in the specular images was calculated using MATLAB. D-sum(endo) and D-ES ratio were compared among FECD, BK, and healthy controls.Results: D-sum(endo) in FECD grade 3 was significantly higher than that in healthy control eyes, FECD patients with mild and moderate guttae, and BK (all P <= 0.040). The D-ES ratio in FECD patients with mild to severe guttae (grade 1-3) was significantly higher than that in healthy control eyes and BK (all P <= 0.035). The percentage of the guttae area was significantly correlated with D-sum(endo) (R = 0.488, P < 0.001 for 3 mm, R = 0.512, P < 0.001 for 6 mm) and D-ES ratio (R = 0.450, P < 0.001 for 3 mm, R = 0.588, P < 0.001 for 6 mm).Conclusions: Descemet membrane reflectivity in AS-OCT can be objective biomarkers for assessing guttae and FECD severity from early to end-stage FECD.