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Laboratory Sciences | July 2012 ONLINE FIRST

Corneal Haze Determined by Confocal Microscopy 2 Years After Descemet Stripping With Endothelial Keratoplasty for Fuchs Corneal Dystrophy

Keith H. Baratz, MD; Jay W. McLaren, PhD; Leo J. Maguire, MD; Sanjay V. Patel, MD

Arch Ophthalmol. 2012;130(7):868-874. doi:10.1001/archophthalmol.2012.73.

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ABSTRACT

Objective To quantify corneal light scatter and its relationship to vision after Descemet stripping with endothelial keratoplasty (DSEK).

Methods Eyes with Fuchs corneal dystrophy were examined before and 1, 3, 6, 12, and 24 months after DSEK. Outcome measures were high- and low-contrast visual acuity, contrast sensitivity, and forward light scatter. Corneal reflectivity (backscatter), expressed in scatter units (SU), was quantified using in vivo confocal microscopy.

Results Comparing 49 study eyes with 35 normal eyes, the mean (SD) corneal subepithelial layer was more reflective than normal before (2325 [613] vs 1208 [287] SU, P < .001) and through 24 months after DSEK (1760 [432] SU, P < .001). Interface reflectivity remained higher than in normal stroma through 24 months (1228 [287] vs 827 [188] SU, P < .001). At 1 year, forward light scatter correlated with subepithelial reflectivity (r = 0.28, P = .01) but not interface reflectivity. Recipient age was correlated with improvement in subepithelial reflectivity at 12 months (r = –0.41, P = .01, 34 eyes) and 24 months (r = – 0.36, P = .02, 26 eyes) after DSEK, and the improvement of subepithelial haze in eyes of participants aged 62 years or younger was correlated with improvement in forward light scatter at 12 months (r = 0.52, P = .008) and 24 months (r = 0.62, P = .004).

Conclusions In Fuchs corneal dystrophy, the corneal subepithelial region is a more important source of forward light scatter than the DSEK interface. Subepithelial haze improves more in younger patients and is associated with improvement in forward light scatter.

Clinical Relevance Visual function after DSEK is affected by residual haze in the anterior host cornea more so than the surgical interface. Haze, which likely is experienced as glare disability, improves after surgical intervention but improves more in younger patients.

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Figure 1. Confocal images and image brightness intensity profiles before Descemet stripping with endothelial keratoplasty (DSEK) and through 2 years after the operation. The confocal images are from an individual cornea and are representative of the subepithelial, host stroma, lamellar wound interface, and donor stroma regions before and at 6 and 24 months after DSEK. Note the increased brightness of the subepithelial region and the surgical interface vs the normal control cornea (top right). The graph demonstrates the mean intensity of confocal brightness through the corneal stroma, with the subepithelial region referenced as 0% depth and the endothelium as 100% depth. The position of the surgical interface was scaled to 72% of depth, the mean interface depth, in each scan before calculating the mean. The brightness of both the subepithelial and interface regions improved partially after the operation. The stroma of the host and donor were similar to normal and did not change significantly during the study period. SU indicates scatter units.

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Figure 2. Relationships between forward light scatter (straylight parameter) and corneal haze (confocal image intensity) at 12 months after Descemet stripping with endothelial keratoplasty. A, In the subepithelial layer, straylight was correlated with image brightness. B, In the surgical interface, no correlation was found. The solid line represents the linear regression fit across all subjects. The Pearson correlation coefficient and Bonferroni-adjusted P value are shown. SU indicates scatter units.

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Figure 3. Improvement in confocal image brightness after Descemet stripping with endothelial keratoplasty (DSEK). A, Improvement in brightness of the subepithelial image at 12 months after DSEK diminished with increasing patient age. B, Improvement in the straylight parameter was directly related to improvement in brightness of the subepithelial image at 12 months after DSEK. The solid line represents the linear regression fit across all subjects. The Pearson correlation coefficient and Bonferroni-adjusted P value are shown. SU indicates scatter units.

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Baratz KH, McLaren JW, Maguire LJ, Patel SV. Corneal Haze Determined by Confocal Microscopy 2 Years After Descemet Stripping With Endothelial Keratoplasty for Fuchs Corneal Dystrophy. Arch Ophthalmol. 2012;130(7):868-874. doi:10.1001/archophthalmol.2012.73.

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Corneal Haze Determined by Confocal Microscopy 2 Years After Descemet Stripping With Endothelial Keratoplasty for Fuchs Corneal Dystrophy

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