Syed Zeba A, Tran Jennifer A, Jurkunas Ula V
*Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA; and †Boston University School of Medicine, Boston, MA.
Cornea. 2017 Oct;36(10):1166-1171. doi: 10.1097/ICO.0000000000001292.
In advanced Fuchs endothelial corneal dystrophy (FECD), central endothelial changes do not correlate with disease severity. The peripheral endothelial cell count (ECC) has not been studied as a marker of FECD severity. The goal of this study was to determine the relationship between the peripheral ECC and known clinical markers of FECD in advanced cases.
Patients with FECD examined between January 1, 2013, and September 1, 2016, by 1 cornea specialist were identified. Medical records from all previous visits were reviewed to include eyes with high-quality central and peripheral in vivo confocal microscopy images performed on the same day as a clinical evaluation. Endothelial photographs were used to perform manual cell counts centrally and peripherally. Clinical grading of FECD from 1 to 4 was performed at the slit-lamp.
We identified 154 eyes of 126 patients that met criteria for inclusion. With higher disease grades, central ECC and peripheral ECC decreased, visual acuity worsened, and central corneal thickness (CCT) increased (all P < 0.05). In patients with advanced disease (defined as either grade 3 or 4, CCT >700, or central ECC <350), the peripheral ECC was the best predictor of disease severity and had the highest number of statistically significant correlations with other clinical markers compared with competing variables.
In advanced FECD, severity is best determined by the peripheral ECC compared with the central ECC, visual acuity, clinical disease grade, and CCT. The peripheral ECC should be added to the clinical parameters used to evaluate FECD severity.
在晚期富克斯内皮性角膜营养不良（FECD）中，中央内皮细胞变化与疾病严重程度不相关。外周内皮细胞计数（ECC）尚未作为FECD严重程度的标志物进行研究。本研究的目的是确定晚期病例中外周ECC与FECD已知临床标志物之间的关系。
确定2013年1月1日至2016年9月1日期间由1名角膜专科医生检查的FECD患者。回顾所有既往就诊的病历，纳入在临床评估当天进行了高质量中央和外周活体共聚焦显微镜检查图像的眼睛。使用内皮细胞照片进行中央和外周的手动细胞计数。在裂隙灯处对FECD进行1至4级的临床分级。
我们确定了126例患者的154只眼睛符合纳入标准。随着疾病等级升高，中央ECC和外周ECC降低，视力恶化，中央角膜厚度（CCT）增加（所有P<0.05）。在晚期疾病患者（定义为3级或4级、CCT>700或中央ECC<350）中，外周ECC是疾病严重程度的最佳预测指标，与其他临床标志物相比，与竞争变量的统计学显著相关性数量最多。
在晚期FECD中，与中央ECC、视力、临床疾病等级和CCT相比，外周ECC最能确定疾病严重程度。外周ECC应添加到用于评估FECD严重程度的临床参数中。
