Epithelial Remodeling And Its Contribution To Higher-Order Aberration Dynamic Changes In Fuchs Endothelial Corneal Dystrophy With Subclinical And Clinical Edema Who Underwent Dmek

To evaluate epithelial changes in eyes with Fuchs endothelial corneal dystrophy (FECD) presenting with subclinical versus clinically evident corneal edema and to investigate the contribution of epithelial remodeling to visual quality before and after Descemet membrane endothelial keratoplasty (DMEK).

Clinical Institute for Opthalmological Emergencies "Prof. Dr. Mircea Olteanu"

In this observational study, eyes with FECD were divided into two groups based on the presence of subclinical edema or clinically evident corneal edema. All eyes underwent preoperative evaluation using anterior segment optical coherence tomography (AS-OCT) with epithelial thickness mapping and corneal tomography with wavefront analysis. Parameters analyzed included epithelial thickness distribution, central corneal thickness, and anterior corneal HOAs. The same parameters were reassessed postoperatively following DMEK. Changes in epithelial profile and optical aberrations were compared within and between the two groups to evaluate epithelial compensation and remodeling after restoration of endothelial function.

Preoperatively, both groups demonstrated epithelial remodeling consistent with a compensatory response to stromal edema, characterized by regional epithelial thickening and irregularity associated with increased anterior corneal HOAs. Following DMEK, restoration of endothelial pump function resulted in epithelial remodelling in both groups. However, the magnitude of epithelial thickness normalization and reduction in HOAs was more pronounced in eyes with clinically evident edema compared with those with subclinical edema.

Corneal epithelial remodeling occurs in both subclinical and clinical stages of FECD and contributes to the optical disturbances observed in the disease. After DMEK, epithelial regularization accompanies stromal deturgescence and improvement in corneal optics, with more marked changes observed in eyes with clinically evident edema. Assessment of epithelial thickness profiles may therefore provide additional insight into disease severity and postoperative optical recovery in FECD.