title: Cellular and subbasal nerve alterations in early stage Fuchs' endothelial corneal dystrophy: an in vivo confocal microscopy study.
abstract: OBJECTIVE
  To analyze the morphology and density of corneal epithelial cells, keratocytes, and subbasal nerves, in patients with early stage Fuchs' endothelial corneal dystrophy (FECD) by in vivo confocal microscopy (IVCM).
  
  
  METHODS
  IVCM (Confoscan 4, Nidek, Inc.) of the central cornea was performed in 30 corneas of 30 patients with early stage FECD and 13 corneas of 13 normal controls. Images were analyzed for morphology and density of the superficial and basal epithelial cells, keratocyte density, endothelial cell density (ECD), as well as subbasal corneal nerve parameters. Central corneal thickness (CCT) was measured in all patients and normals by ultrasound pachymetry.
  
  
  RESULTS
  The ECD was significantly lower (-45.5%, P<0.001) in FECD patients as compared with controls. Total number of nerves and main nerve trunks were significantly reduced (-46.3%, P<0.001; -39.7%, P<0.001) in patients with FECD. Posterior keratocyte density was significantly higher in FECD patients (P<0.001). Significant inverse correlations were found between CCT and total number of nerves (r=-0.69, P<0.001), CCT and main nerve trunks (-0.47, P=0.016), as well as CCT and total nerve length (r=-0.62, P=0.006). Significant correlation was found between ECD and total number of nerves (r=0.44, P=0.012) as well as between ECD and main nerve trunks (r=0.65, P<0.001).
  
  
  CONCLUSIONS
  IVCM demonstrates alterations in corneal innervation in patients with early stage FECD, suggesting a potential role of corneal nerves in the pathogenesis of FECD. Additional studies are required to investigate whether subbasal nerve alterations are caused by nonspecific corneal edema, from FECD-induced decrease in ECD, or potentially leading to loss of endothelial cells.
authors.affiliation: Department of Ophthalmology, Cornea Service and Ocular Surface Imaging Center, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Schrems-Hoesl
authors.forename: W A
authors.initials: WA
authors.lastname: Schrems
authors.forename: A
authors.initials: A
authors.lastname: Cruzat
authors.forename: B M
authors.initials: BM
authors.lastname: Shahatit
authors.forename: H A
authors.initials: HA
authors.lastname: Bayhan
authors.forename: U V
authors.initials: UV
authors.lastname: Jurkunas
authors.forename: P
authors.initials: P
authors.lastname: Hamrah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000294:innervation*; D060527:Corneal Keratocytes / Q000166:cytology; D063171:Corneal Pachymetry; D003430:Cross-Sectional Studies; D004728:Endothelium, Corneal / Q000166:cytology; D019573:Epithelium, Corneal / Q000166:cytology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009882:Ophthalmic Nerve / Q000473:pathology*; D012189:Retrospective Studies; D014463:Ultrasonography