Relationship between Corneal Guttae and Quality of Vision in Patients with Mild Fuchs' Endothelial Corneal Dystrophy

Watanabe, Shinya; Oie, Yoshinori; Fujimoto, Hisataka; Soma, Takeshi; Koh, Shizuka; Tsujikawa, Motokazu; Maeda, Naoyuki; Nishida, Kohji

doi:10.1016/j.ophtha.2015.06.019

Cited by 76 publications

(59 citation statements)

References 35 publications

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“…The DM in FED is characterized by the presence of guttae. In addition to degrading vision 26 and hindering endothelial from the areas outlined underwent neighbor analysis, with the results projected below. Those in the periphery, being the first to migrate, display a more ''mature'' architecture than those in the center, with smaller cells and a greater hexagonality ratio.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst they show this strategy is successful in some patients with FED, it fails to work in those with iridoplasty-related bullous keratopathy, a variation of PBK, suggesting the effect likely involves migration of healthy cells from the reserve in the periphery. [23][24][25] However, a problem with this approach is that it leaves behind the guttae, which in addition to scattering light and degrading vision, 26 can have a significant negative impact on migration of endothelial cells. 27 Hence, an alternative approach has been to perform a procedure termed ''primary descemetorhexis.''…”

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confidence: 99%

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Allogeneic Descemet's Membrane Transplantation Enhances Corneal Endothelial Monolayer Formation and Restores Functional Integrity Following Descemet's Stripping

Bhogal

Lwin

Seah

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Allogeneic Descemet's Membrane Transplantation Enhances Corneal Endothelial Monolayer Formation and Restores Functional Integrity Following Descemet's Stripping

Bhogal

Lwin

Seah

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…They suggested that increased posterior HOAs due to guttae are responsible for decreased vision, even in the absence of clinically detectable corneal edema [ 22 ]. Watanabe and colleagues also showed that the presence of guttae negatively correlates with clinical parameters for quality of vision, such as corrected distance visual acuity, letter contrast sensitivity, and stray light [ 23 ]. They assumed that guttae induce irregularity and posterior corneal opacity, resulting in an increase in forward light scatter [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of cell-based therapy combined with descemetorhexis for treating Fuchs endothelial corneal dystrophy in rabbit model

et al. 2018

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Corneal transparency is maintained by the corneal endothelium through its pump and barrier function. Severe corneal endothelial damage results in dysregulation of water flow and eventually causes corneal haziness and deterioration of visual function. In 2013, we initiated clinical research of cell-based therapy for treating corneal decompensation. In that study, we removed an 8-mm diameter section of damaged corneal endothelium without removing Descemet’s membrane (the basement membrane of the corneal endothelium) and then injected cultured human corneal endothelial cells (CECs) into the anterior chamber. However, Descemet’s membrane exhibits clinically abnormal structural features [i.e., multiple collagenous excrescences (guttae) and thickening] in patients with Fuchs endothelial corneal dystrophy (FECD) and the advanced cornea guttae adversely affects the quality of vision, even in patients without corneal edema. The turnover time of cornea guttae is also not certain. Therefore, we used a rabbit model to evaluate the feasibility of Descemet’s membrane removal in the optical zone only, by performing a small 4-mm diameter descemetorhexis prior to CEC injection. We showed that the corneal endothelium is regenerated both on the corneal stroma (the area of Descemet’s membrane removal) and on the intact peripheral Descemet’s membrane, based on the expression of function-related markers and the restoration of corneal transparency. Recovery of the corneal transparency and central corneal thickness was delayed in areas of Descemet’s membrane removal, but the cell density of the regenerated corneal endothelium and the thickness of the central corneal did not differ between the areas with and without residual Descemet’s membrane at 14 days after CEC injection. Here, we demonstrate that removal of a pathological Descemet’s membrane by a small descemetorhexis is a feasible procedure for use in combination with cell-based therapy. The current strategy might be beneficial for improving visual quality after CEC injection as a treatment for FECD.

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“…Corneal guttae reduce contrast sensitivity and by implanting premium IOL, a second source of optical degradation is added. 7,8 Corneal surface aberrations, in combination with premium IOLs, can result in high visual dissatisfaction. Photopic phenomena (38.2%) and blurred vision (36.8%) are the most common presenting symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Photopic phenomena (38.2%) and blurred vision (36.8%) are the most common presenting symptoms. 9 A study by Watanabe et al 8 concluded that straylight from corneal guttae may be the main cause of optical degradation. Quantification of corneal guttae may offer a method for objectively evaluating quality of vision in patients with FED, even those who have cataract.…”

Section: Discussionmentioning

confidence: 99%

Visual outcome after trifocal IOL implant in a patient with cornea guttata. A case report.

Valdez-García¹,

Ortiz-Morales

Morales-Mancillas

et al. 2019

Preprint

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Background We report the case and management of a patient that started with primary cornea guttata symptoms after cataract surgery with trifocal intraocular lens (IOL) implant. The unusual postoperative presentation of the disease in association with a trifocal IOL resulted in increased corneal surface aberrations that resulted in visual dissatisfaction. Case presentation A 67 year-old male was evaluated due to blurred vision for two months, as well as a desire to stop using glasses in his everyday life. At the initial refraction, myopia, corneal astigmatism and nuclear cataract were diagnosed in both eyes. A nuclear cataract was diagnosed in both eyes. Phacoemulsification surgery was performed in OS, implanting a trifocal IOL. The postoperative refraction in OS was -1.25DCx120º, with a best-corrected visual acuity (BCVA) of 20/20. Six months later, the patient kept complaining of blurred vision and night glare. In slit lamp examination, corneal guttae were denoted and changes in corneal endothelium morphology suggested primary cornea guttata. A monofocal IOL exchange was performed in order to reduce corneal aberrations with excellent outcome at 2-year follow up. Conclusions Screening for endothelial dysfunction is a key element for successful outcomes in cataract surgery. Corneal guttae accent optical aberrations when in combination with premium IOLs.

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Relationship between Corneal Guttae and Quality of Vision in Patients with Mild Fuchs' Endothelial Corneal Dystrophy

Cited by 76 publications

References 35 publications

Allogeneic Descemet's Membrane Transplantation Enhances Corneal Endothelial Monolayer Formation and Restores Functional Integrity Following Descemet's Stripping

Allogeneic Descemet's Membrane Transplantation Enhances Corneal Endothelial Monolayer Formation and Restores Functional Integrity Following Descemet's Stripping

Feasibility of cell-based therapy combined with descemetorhexis for treating Fuchs endothelial corneal dystrophy in rabbit model

Visual outcome after trifocal IOL implant in a patient with cornea guttata. A case report.

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