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A Semi-automated Image Analysis Determination of Regional Differences in Corneal Endothelial Cell Densities in Fuchs
Tasha Miller1, Fahad Butt2, Stephan Ong Tone3,4,5
1Temerty School of Medicine, University of Toronto, Toronto, ON, Canada.
Purpose:
Fuchs endothelial corneal dystrophy (FECD) is characterized by progressive corneal endothelial cell loss and guttae formation, leading to edema and vision loss. This study quantifies regional differences in endothelial cell density (ECD) across FECD grades defined by the modified Krachmer grading system.
Methods:
Medical records from 2023 to 2024 were retrospectively reviewed to identify patients with FECD who underwent noncontact specular microscopy (Konan Specular CellCheck20Plus). Eyes with analyzable peripheral and available central images were included. ECD (cells/mm2) was determined using semi-automated image analysis from central and 4 peripheral regions 4.0 mm from the apex: superonasal (SN), superotemporal (ST), inferonasal (IN), and inferotemporal (IT).
Results:
A total of 104 eyes from 66 patients with FECD were analyzed [mean age 66 ± 11 years (range, 41-88); 71% female]. Central ECD was significantly lower than all peripheral regions in grade 4 (central: 757 cells/mm2; ST: 2043; SN: 1613; IT: 1429; IN: 1702; all P < 0.01), although measurements may be underestimated in advanced disease because of guttae-related limitations. By grade 5, the central-inferotemporal difference was no longer significant (central: 558; IT: 763; P = 0.80), and IT ECD remained lower than superior regions (ST: 1440; SN: 1333, both P < 0.05). By grade 6, central and IT ECD were significantly lower than other regions (all P < 0.05). Sex and diabetes were not independent predictors of ECD (P = 0.76 and P = 0.19, respectively).
Conclusions:
ECD is differentially affected across corneal regions at different FECD grades. Central and IT ECD are more severely affected than other peripheral regions in advanced FECD, although central estimates may be limited.
