Imaging the Corneal Endothelium in Fuchs Corneal Endothelial Dystrophy

Abstract

Fuchs endothelial corneal dystrophy (FECD) is characterized by the progressive degeneration of the corneal endothelium (CE). The purpose of this article is to review the diagnostic tools available to image and assess the CE in FECD. Slit-lamp biomicroscopy with specular reflection and retroillumination are important techniques to assess the CE. Objective diagnostic tests, such as retroillumination photographic analysis, specular microscopy, in vivo confocal microscopy (IVCM), and anterior segment optical coherence tomography, are valuable tools to evaluate the CE in FECD. Specular microscopy can be performed rapidly without touching the eye but requires a clear cornea with a smooth CE. In contrast, IVCM can image all layers of the cornea, even in advanced FECD. However, IVCM is contact-based and more technically challenging. It is important to select the appropriate objective diagnostic test to image and assess the CE in managing patients with FECD.

Keywords: Confocal; Fuchs; cornea; endothelium; specular.

Figure 1.. Slit-lamp photograph using retroillumination in a Fuchs endothelial corneal dystrophy subject.

Confluent guttae (solid arrow head) and individual guttae (double arrow head) are visualized.

Figure 2.. Non-contact specular microscopy and in vivo confocal microscopy (IVCM) in healthy and Fuchs endothelial corneal dystrophy (FECD) subjects.

(A) Non-contact specular microscopy in a healthy subject. (B) IVCM in a healthy subject. (C) Non-contact specular microscopy in a FECD subject with stage 3 guttae (solid arrowhead) (D) IVCM in a FECD subject with stage 1 guttae (arrow) (E) Non-contact specular microscopy in a FECD subject with stage 2 guttae (solid arrowhead) and stage 3 guttae (double arrowhead) (F) IVCM in a FECD subject with stage 1 guttae (arrow) and stage 2 guttae (solid arrowhead).