Endothelial–Descemet Membrane Complex Optical Tomography for Diagnosis of Corneal Endothelial Cell Dysfunction

Abou Shousha, Mohamed

Endothelial–Descemet Membrane Complex Optical Tomography for Diagnosis of Corneal Endothelial Cell Dysfunction

Tuesday, April 21, 2015: 8:56 AM

Room 3 (San Diego Convention Center)

Mohamed Abou Shousha, MD, PhD

Joshua Abernathy, BS

Sean L. Edelstein, MD

Matthew Council, MD

Zachary P. Schmitz, BA

Ravi Shah, BS

Rocio Bentivegna, MD

Jianhua Wang, MD, PhD

Sonia H. Yoo, MD

Victor L. Perez, MD

Purpose
To evaluate the use of Endothelial/Descemet’s membrane complex (En/DM) optical tomography in the diagnosis of endothelial cell dysfunction in Fuchs' endothelial dystrophy (FED) and cornea graft rejection.

Methods
In our prospective case-control study, 84 eyes (20 age matched controls, 29 clear corneal grafts, 5 FED with no corneal edema, 16 FED with decompensated corneas and 14 rejected corneal graft) were imaged using spectral domain optical coherence tomography (OCT). En/DM complex was identified on the OCT images as two hyper-reflective tissue bands with an intervening hypo-reflective band on the posterior surface of the cornea. En/DM central thickness (EN/DM-t) was measured on obtained images. Corneal endothelial dysfunction was diagnosed based on slit lamp examination by a cornea specialist.

Results
In decompensated FED and in rejected corneal grafts, EN/DM-t was highly significantly thicker than controls (44 vs 17 mm; P<.0001). EN/DM-t correlated highly significantly with the severity of corneal decompensation as measured by the total corneal thickness (0.93, P<.0001). EN/DM-t showed excellent predictive accuracy in the diagnosis of endothelial dysfunction in rejected corneal grafts and FED (Area under the curve were 1 and 0.994, respectively; P<.0001). ED/DM-t achieved 100% sensitivity and specificity in the diagnosis of endothelial dysfunction in rejected corneal grafts (cutoff value: 24 mm), whereas, in FED, it showed 100% sensitivity and 96% specificity (cutoff value: 21 mm).

Conclusion
Endothelial/Descemet’s membrane complex optical tomography is a novel technique for the diagnosis of corneal endothelial dysfunction. Endothelial/Descemet’s membrane complex thickness (En/DM-t) showed excellent accuracy, sensitivity and specificity in the diagnosis of endothelial dysfunction in Fuchs’ endothelial dystrophy and corneal grafts. EN/DM-T accurately describes the severity of the endothelial dysfunction.