Long-term Evaluation of Endothelial Cell Changes in Fuchs Corneal Dystrophy: The Influence of Phacoemulsification and Penetrating Keratoplasty
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To evaluate the natural course of the long-term endothelial cell changes in Fuchs corneal dystrophy(FCD) patients and investigate the effects of phacoemulsification on the annual rate of change in endothelialindices in FCD patients. Methods: Thirty-four patients diagnosed with FCD at Seoul National University Hospital from 1994 to 2010were retrospectively reviewed. Sixteen patients who had been followed up for more than 1 year were selectedand classified into 3 groups: group A, patients with no ocular surgery; group B, patients who had undergonephacoemulsification only; and group C, patients who had undergone penetrating keratoplasty with cataractsurgery. Endothelial cell density, polymegethism, pleomorphism, and pachymetry were measured and the exponentialrates of endothelial cell and pachymetry change were analyzed. Results: A non-linear mixed model of non-operated FCD patients showed that only pachymetric data tended toincrease with statistical significance (p = 0.001) with a mean follow-up period of 4.15 years. Using an exponentialregression analysis fitting curve, the mean rates of annual endothelial cell loss were 0.82%/yr, 20.39%/yr,and 29.27%/yr in groups A, B, and C respectively, and statistical significance was seen only in group C (p <0.05). Conclusions: Retrospective long-term follow-up data showed that changes in endothelial density did not significantlydecrease over at least 4 years in middle-aged FCD patients. The changes in pachymetric cornealthickness appeared to increase over the same period. Considering that no exponential changes were aggravatedafter performing cataract surgery alone, cataract surgery would be a preferable option in FCD patientscompared to an approach of “wait-and-do” penetrating keratoplasty combined with cataract surgery.
Abstract
Purpose: To evaluate the natural course of the long-term endothelial cell changes in Fuchs corneal dystrophy(FCD) patients and investigate the effects of phacoemulsification on the annual rate of change in endothelialindices in FCD patients. Methods: Thirty-four patients diagnosed with FCD at Seoul National University Hospital from 1994 to 2010were retrospectively reviewed. Sixteen patients who had been followed up for more than 1 year were selectedand classified into 3 groups: group A, patients with no ocular surgery; group B, patients who had undergonephacoemulsification only; and group C, patients who had undergone penetrating keratoplasty with cataractsurgery. Endothelial cell density, polymegethism, pleomorphism, and pachymetry were measured and the exponentialrates of endothelial cell and pachymetry change were analyzed. Results: A non-linear mixed model of non-operated FCD patients showed that only pachymetric data tended toincrease with statistical significance (p = 0.001) with a mean follow-up period of 4.15 years. Using an exponentialregression analysis fitting curve, the mean rates of annual endothelial cell loss were 0.82%/yr, 20.39%/yr,and 29.27%/yr in groups A, B, and C respectively, and statistical significance was seen only in group C (p <0.05). Conclusions: Retrospective long-term follow-up data showed that changes in endothelial density did not significantlydecrease over at least 4 years in middle-aged FCD patients. The changes in pachymetric cornealthickness appeared to increase over the same period. Considering that no exponential changes were aggravatedafter performing cataract surgery alone, cataract surgery would be a preferable option in FCD patientscompared to an approach of “wait-and-do” penetrating keratoplasty combined with cataract surgery.
참고문헌 (20)
- Borboli S, "Mechanisms of disease : Fuchs’ endothelial dystrophy", Ophthalmol Clin North Am, 15, pp.17~25 (2002)
- Adamis AP, "Fuchs’ endothelial dystrophy of the cornea", Surv Ophthalmol, 38, pp.149~168 (1993)
- Lietman T, "Those excrescences on Descemet’s membrane", Br J Ophthalmol, 87, pp.515~516 (2003)
- Cross HE, "Inheritance of Fuchs’ endothelial dystrophy", Arch Ophthalmol, 85, pp.268~272 (1971)
- Magovern M, "Inheritance of Fuchs’ combined dystrophy", Ophthalmology, 86, pp.1897~1923 (1979)
- Li QJ, "The role of apoptosis in the pathogenesis of Fuchs endothelial dystrophy of the cornea", Arch Ophthalmol, 119, pp.1597~1604 (2001)
- Gottsch JD, "Serial analysis of gene expression in the corneal endothelium of Fuchs’ dystrophy", Invest Ophthalmol Vis Sci, 44, pp.594~599 (2003)
- Macnamara E, "Aquaporin-1 expression is decreased in human and mouse corneal endothelial dysfunction", Mol Vis, 10, pp.51~56 (2004)
- Szentmary N, "Epithelial cell, keratocyte, and endothelial cell apoptosis in Fuchs’ dystrophy and in pseudophakic bullous keratopathy", Eur J Ophthalmol, 15, pp.17~22 (2005)
- Bourne WM, "Central corneal endothelial cell changes over a ten-year period", Invest Ophthalmol Vis Sci, 38, pp.779~782 (1997)
- Roszkowska AM, "Age-related modifications of the corneal endothelium in adults", Int Ophthalmol, 25, pp.163~166 (2004)
- Inoue K, "Morphological study of corneal endothelium and corneal thickness in pseudoexfoliation syndrome", Jpn J Ophthalmol, 47, pp.235~239 (2003)
- Sihota R, "Corneal endothelial status in the subtypes of primary angle closure glaucoma", Clin Experiment Ophthalmol, 31, pp.492~495 (2003)
- Patel SV, "Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty", Trans Am Ophthalmol Soc, 102, pp.57~65 (2004)
- Ing JJ, "Ten-year postoperative results of penetrating keratoplasty", Ophthalmology, 105, pp.1855~1865 (1998)
- Seitzman GD, "Cataract surgery in patients with Fuchs’ corneal dystrophy : expanding recommendations for cataract surgery without simultaneous keratoplasty", Ophthalmology, 112, pp.441~446 (2005)
- Afshari NA, "Clinical study of Fuchs corneal endothelial dystrophy leading to penetrating keratoplasty : a 30-year experience", Arch Ophthalmol, 124, pp.777~780 (2006)
- Seitzman GD, "Cataract surgery in Fuchs’ dystrophy", Curr Opin Ophthalmol, 16, pp.241~245 (2005)
- Eghrari AO, "Cataract surgery in Fuchs corneal dystrophy", Curr Opin Ophthalmol, 21, pp.15~19 (2010)
- Traish AS, "Approaching cataract surgery in patients with fuchs’ endothelial dystrophy", Int Ophthalmol Clin, 50, pp.1~11 (2010)