Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Graefes Arch Clin Exp Ophthalmol. 2021 Mar;259(3):685-690. doi: 10.1007/s00417-020-04985-1. Epub 2020 Oct 31.
Common methods of measuring severity of Fuchs endothelial corneal dystrophy (FECD) are limited in objectivity, reliability, or start with a variable baseline that prevents distinguishing healthy from affected eyes. The aim of this study was to describe a method of grading FECD that overcomes these limitations.
Fifteen patients with Fuchs endothelial corneal dystrophy were included in the study. Guttae were imaged with a slit lamp beam 8 mm tall; the bottom 4 mm half of each image was divided into two equally-sized sections. Guttae were counted by four independent graders blinded to disease severity scores. The peripheral:central guttae ratio was compared to modified Krachmer clinical severity scores. The peripheral:central guttae ratio was compared between mild (severity 0.5-3) versus moderate-to-severe (severity 4-5) disease. Receiver operating characteristics defined optimal ratio cutoffs for mild versus moderate-to-severe disease.
Increased peripheral guttae and peripheral:central guttae ratio correlated with Krachmer severity (p = 0.021 and p = 0.009, respectively). The difference between mild and moderate-to-severe cases for the peripheral:central guttae ratio was significant (p < 0.001). Inter-rater reliability of total guttae count was high (coefficient = 0.82, p < 0.001). A peripheral:central guttae ratio of 0.16 was the ideal cut-off point (area under the curve = 0.79, sensitivity = 0.78, and specificity = 0.80).
In this pilot study, the peripheral:central ratio of guttae correlates with subjective clinical severity of Fuchs dystrophy. It starts at a common baseline, has good inter-rater reliability, does not require dilation, and can be conducted with a smartphone and slit-lamp.
评估 Fuchs 角膜内皮营养不良（FECD）严重程度的常用方法在客观性、可靠性方面存在局限，或者以可变的基线为起点，无法区分健康眼和患病眼。本研究旨在描述一种可克服这些局限性的 FECD 分级方法。
本研究纳入 15 名 FECD 患者。使用高 8mm 的裂隙灯光束对胶滴进行成像；将每个图像的底部 4mm 分为两个大小相等的区域。四位独立的评分员在不了解疾病严重程度评分的情况下对胶滴进行计数。将周边：中央胶滴比与改良的 Krachmer 临床严重程度评分进行比较。比较轻度（严重程度 0.5-3）与中重度（严重程度 4-5）疾病之间的周边：中央胶滴比。受试者工作特征曲线确定了轻度与中重度疾病之间的最佳比值截断值。
周边胶滴数量和周边：中央胶滴比与 Krachmer 严重程度呈正相关（p=0.021 和 p=0.009）。轻度与中重度病例之间的周边：中央胶滴比差异有统计学意义（p<0.001）。总胶滴计数的组内相关系数很高（系数=0.82，p<0.001）。周边：中央胶滴比为 0.16 是理想的截断点（曲线下面积=0.79，敏感性=0.78，特异性=0.80）。
在这项初步研究中，胶滴的周边：中央比值与 Fuchs 营养不良的主观临床严重程度相关。它以常见的基线为起点，具有良好的组内一致性，不需要散瞳，可使用智能手机和裂隙灯进行检测。
