Taher Eleiwa1, Amr Elsawy2, Mohamed Tolba3, William Feuer4, Sonia Yoo4, Mohamed Abou Shousha5. 1. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Department of Ophthalmology, Faculty of Medicine, Benha University, Banha, Egypt. 2. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Electrical and Computer Engineering, University of Miami, Miami, Florida. 3. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; International Medical Center, Egyptian Armed Forces, Cairo, Egypt. 4. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida. 5. Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida; Electrical and Computer Engineering, University of Miami, Miami, Florida; Department of Biomedical Engineering, University of Miami, Miami, Florida. Electronic address: MShousha@med.miami.edu.
Abstract
PURPOSE: To describe the diagnostic accuracy of 3-dimensional (3D) endothelium-Descemet's membrane complex thickness (En-DMT) in Fuchs' endothelial corneal dystrophy (FECD) and determine its potential role as an objective index of disease severity. DESIGN: Observational case-control study. PARTICIPANTS: One hundred four eyes of 79 participants (64 eyes of 41 FECD patients and 40 eyes of 38 healthy controls). METHODS: All participants received high-definition OCT imaging (Envisu R2210; Bioptigen, Buffalo Grove, IL). Fuchs' endothelial corneal dystrophy was classified clinically into early-stage (without edema) and late-stage (with edema) disease. Automatic and manual segmentation of corneal layers was performed using a custom-built segmental tomography algorithm to generate 3D maps of total corneal thickness (TCT) and En-DMT of the central 6-mm cornea. Regional En-DMT, regional TCT, and central-to-peripheral total corneal thickness ratio (CPTR) were evaluated and correlated to the clinical severity of FECD. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to assess the reliability of the repeated measurements in all eyes. MAIN OUTCOME MEASURES: Central-to-peripheral total corneal thickness ratio and average En-DMT and TCT of central, paracentral, and peripheral regions. RESULTS: In FECD, a significant increase in En-DMT, CPTR, and TCT was found compared to controls (P < 0.001). For identifying FECD, average En-DMT of paracentral and peripheral regions achieved 94% sensitivity and 100% specificity (cutoffs, 19 μm and 20 μm, respectively), whereas CPTR showed 94% sensitivity with a 73% specificity (cutoff, 0.97). Regarding early-stage FECD, average En-DMT of central zones achieved 92% sensitivity and 97% specificity (cutoff, 18 μm), whereas CPTR showed 90% sensitivity and 88% specificity (cutoff, 0.97). The average En-DMT of central, paracentral, and peripheral regions was correlated highly with FECD clinical stage (Spearman's ρ = 0.813, 0.793, and 0.721, respectively; all P < 0.001), compared with CPTR and mean TCT of paracentral zones (0.672 and 0.481, respectively; P < 0.001). The ICC values ranged from 0.98 (En-DMT) to 0.99 (TCT) with a good agreement between the automatic and manual measurements. CONCLUSIONS: Regional 3D En-DMT is a novel diagnostic tool of FECD that can be used to quantify the disease severity with excellent reliability.
PURPOSE: To describe the diagnostic accuracy of 3-dimensional (3D) endothelium-Descemet's membrane complex thickness (En-DMT) in Fuchs' endothelial corneal dystrophy (FECD) and determine its potential role as an objective index of disease severity. DESIGN: Observational case-control study. PARTICIPANTS: One hundred four eyes of 79 participants (64 eyes of 41 FECDpatients and 40 eyes of 38 healthy controls). METHODS: All participants received high-definition OCT imaging (Envisu R2210; Bioptigen, Buffalo Grove, IL). Fuchs' endothelial corneal dystrophy was classified clinically into early-stage (without edema) and late-stage (with edema) disease. Automatic and manual segmentation of corneal layers was performed using a custom-built segmental tomography algorithm to generate 3D maps of total corneal thickness (TCT) and En-DMT of the central 6-mm cornea. Regional En-DMT, regional TCT, and central-to-peripheral total corneal thickness ratio (CPTR) were evaluated and correlated to the clinical severity of FECD. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to assess the reliability of the repeated measurements in all eyes. MAIN OUTCOME MEASURES: Central-to-peripheral total corneal thickness ratio and average En-DMT and TCT of central, paracentral, and peripheral regions. RESULTS: In FECD, a significant increase in En-DMT, CPTR, and TCT was found compared to controls (P < 0.001). For identifying FECD, average En-DMT of paracentral and peripheral regions achieved 94% sensitivity and 100% specificity (cutoffs, 19 μm and 20 μm, respectively), whereas CPTR showed 94% sensitivity with a 73% specificity (cutoff, 0.97). Regarding early-stage FECD, average En-DMT of central zones achieved 92% sensitivity and 97% specificity (cutoff, 18 μm), whereas CPTR showed 90% sensitivity and 88% specificity (cutoff, 0.97). The average En-DMT of central, paracentral, and peripheral regions was correlated highly with FECD clinical stage (Spearman's ρ = 0.813, 0.793, and 0.721, respectively; all P < 0.001), compared with CPTR and mean TCT of paracentral zones (0.672 and 0.481, respectively; P < 0.001). The ICC values ranged from 0.98 (En-DMT) to 0.99 (TCT) with a good agreement between the automatic and manual measurements. CONCLUSIONS: Regional 3D En-DMT is a novel diagnostic tool of FECD that can be used to quantify the disease severity with excellent reliability.
Authors: Taher Eleiwa; Amr Elsawy; Eyup Ozcan; Collin Chase; William Feuer; Sonia H Yoo; Victor L Perez; Mohamed F Abou Shousha Journal: Sci Rep Date: 2021-07-15 Impact factor: 4.379