Multimodal Imaging In Different Types Of Fuchs Endothelial Dystrophy

Based on multimodal imaging of patients  with Fuchs endothelial dystrophy, we propose a new classification, underlining 5 different types of FECD with distinctive imagistic findings, advocating specific corneal behaviour, optical quality and visual improvement after DMEK. A pathological classification has identified distinct phenotypes of Fuchs Endothelial Corneal Dystrophy (FECD), underscoring the biological heterogeneity. However, that classification is currently based on ex vivo Descemet membrane analysis. The ability to identify characteristics of these pathological types in vivo through multimodal non-invasive imaging such as AS-OCT and IVCM could provide a critical link between histopathology, disease behavior, and surgical timing.

Clinical Institute of Ophthalmological Emergencies " Prof. Dr. Mircea Olteanu"

Patients diagnosed with FECD who underwent DMEK between January 2023 and December 2025 were included. All patients underwent comprehensive ophthalmological evaluation, AS-OCT, and IVCM preoperatively and at 12 months postoperatively. When available, excised Descemet membranes were preserved for histopathological analysis. Qualitative and quantitative AS-OCT and IVCM parameters including pachymetry, optical quality metrics, Descemet membrane morphology, and corneal nerve features were analyzed.

Several distinctive patterns have been identified using AS-OCT and IVCM parameters across the FECD patient cohort. Certain patterns seem to be associated with more advanced or rapidly progressive disease, while others were associated with structurally and functionally more stable corneas. These imaging-defined phenotypes appeared to correspond to the recently proposed pathological FECD classification, suggesting that specific histological patterns may have recognizable in vivo correlates.

If validated, this integrated approach could support earlier risk stratification and a more personalized timing for endothelial keratoplasty. Further prospective studies integrating imaging, pathology, and functional outcomes are warranted.