title: Corneal nerve alterations in different stages of Fuchs' endothelial corneal dystrophy: an in vivo confocal microscopy study.
abstract: OBJECTIVE
  To analyze potential alterations in corneal nerve morphology and function in different stages of Fuchs' endothelial corneal dystrophy (FECD).
  
  
  METHODS
  Thirty eyes with FECD underwent in vivo confocal microscopy using the Heidelberg Retina Tomograph II (HRT II; Heidelberg Engineering, Heidelberg, Germany) and the Rostock Cornea Module (RCM) to quantify the morphology of the central subbasal corneal nerve plexus (total nerve length, total nerve number, number of main nerve trunks, number of nerve branches) as well as esthesiometry (using the Cochet-Bonnet esthesiometer) of the central cornea to determine central corneal sensation as a measure of nerve function. Findings were correlated with an age-matched control group of 30 healthy individuals. Comparisons to biomicroscopical stage of FECD, visual acuity and central corneal thickness were performed using Spearman correlation.
  
  
  RESULTS
  Depending on slit-lamp examination, all 30 eyes were classified into FECD stage 1-4 (stage 1: six eyes; stage 2: 15 eyes; stage 3: six eyes; stage 4: three eyes). Total nerve length (ρ = -0.8, p < 0.001), total nerve number (ρ = -0.7, p < 0.001), number of main nerve trunks (ρ = -0.6, p < 0.001), and number of nerve branches (ρ = -0.7, p < 0.001) decreased significantly with increasing FECD stages. Comparing to the visual acuity, significant positive correlations were found for total nerve length (ρ = 0.5, p = 0.012), total nerve number (ρ = 0.5, p = 0.005), number of main nerve trunks (ρ = 0.4, p = 0.017), and number of nerve branches (ρ = 0.5, p = 0.009). With central corneal thickness, there were significant inverse correlations for total nerve length (ρ = -0.6, p = 0.001), total nerve number (ρ = -0.5, p = 0.012), number of main nerve trunks (ρ = -0.4, p = 0.015), and number of nerve branches (ρ = -0.4, p = 0.017). Central corneal sensation was full in all FECD stage 1, stage 2 and stage 3 eyes, but mildly reduced in FECD stage 4 eyes.
  
  
  CONCLUSIONS
  Increasing severity of Fuchs' endothelial corneal dystrophy (FECD) is concurrent with marked attenuation of the density, as well as mild diminishment of the function, of the subbasal corneal nerve plexus in late stage of the disease.
authors.affiliation: Department of Ophthalmology, University of Cologne, Kerpener Strasse, Cologne, 62-50924, Germany, franziskabucher@yahoo.de.
authors.forename: Franziska
authors.initials: F
authors.lastname: Bucher
authors.forename: Werner
authors.initials: W
authors.lastname: Adler
authors.forename: Helmar C
authors.initials: HC
authors.lastname: Lehmann
authors.forename: Deniz
authors.initials: D
authors.lastname: Hos
authors.forename: Philipp
authors.initials: P
authors.lastname: Steven
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
authors.forename: Ludwig M
authors.initials: LM
authors.lastname: Heindl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000294:innervation* / Q000503:physiopathology; D003389:Cranial Nerve Diseases / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009415:Nerve Net / Q000473:pathology; D009882:Ophthalmic Nerve / Q000473:pathology*; D011446:Prospective Studies; D012677:Sensation / Q000502:physiology