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