Criteria To Identify True Keratoconus In Patients With Fuchs Endothelial Corneal Dystrophy
Published 2023 - 41st Congress of the ESCRS
Reference: FP06.01 | Type: Free paper | DOI: 10.82333/f8jf-v068
Authors: ziv Rotfogel* 1 , Cristina Bovone 2 , Rossella Spena 2 , Massimo Busin 3
1Ophthalmology,Kaplan Medical Center,Rehovot,Israel;Hadassah Medical School Faculty of Medicine,The Hebrew University, Jerusalem,Israel;Ophthalmology,Ospedali Privati Forlì “Villa Igea”,Forlì,Italy, 2Ophthalmology,Ospedali Privati Forlì “Villa Igea”,Forlì,Italy;Department of Translational Medicine,University of Ferrara,Ferrara,Italy, 3Ophthalmology,Ospedali Privati Forlì “Villa Igea”,Forlì,Italy;Department of Translational Medicine,University of Ferrara,Ferrara,Italy;Ophthalmology,Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO),Forlì,Italy
Purpose
Guttae concentrating in the paracentral cornea of patients with Fuchs endothelial corneal dystrophy (FECD) may cause a focal area of anterior steepening, identified on the topographic map as “hot spot”, thus leading to the misdiagnosis of concomitant keratoconus (KC). In an attempt at establishing criteria for the proper diagnosis of corneal ectasia in the presence of FECD, we investigated the family history, individual clinical findings, as well as topographic and tomographic characteristics of patients with FECD and topographic hot spot.
Setting
A retrospective, single-center study.
Methods
This study includes 49 eyes of 41 patients that presented at our Institution between January 2017 and March 2022 with concomitant FECD and topographic hot spot. For all patients, family history of ectasia was investigated, slit-lamp examination was performed to assess the presence of Vogt striae in concomitance with guttae, and anterior segment optical coherence tomography (AS-OCT) was used to determine the presence of focal posterior corneal elevation. In the absence of all 3 parameters, hot spot was considered secondary to focal edema and endothelial keratoplasty (EK) was performed. AS-OCT was repeated 6 months after surgery in eyes that underwent EK.
Results
Of the 49 included eyes, 22 (45%) had at least one of the 3 diagnostic criteria for KC. Of those, all 22 had focal posterior corneal elevation, 1 had positive family history of KC in the absence of guttae and 3 had Vogt striae. In the remaining 27 eyes (55%) with pseudo-KC, EK was performed. Corneas with FECD and true keratoconus had a significantly higher average K and a significantly lower thinnest point in comparison to eyes with pseudo-KC due to focal edema (46.84 ± 4.51D vs 44.54 ± 1.82D, P = 0.033 and 509.64 ± 71.18µ vs 593.04 ± 48.64µ, P < 0.0001 respectively). After EK, the topographic hot spot resolved in all 27 patients.
Conclusions
FECD and KC may coexist in the same patient. Focal posterior corneal elevation, family history and Vogt striae are instrumental in differentiating FECD patients with true KC from those with pseudo-KC due to focal edema. Hot spots in eyes with pseudo-KC resolved following EK.
.