Preoperative host imaging markers of outcome following Descemet Membrane Endothelial Keratoplasty

Brief Lay Background

The cornea is the clear, outer layer at the front of the eye. Its innermost layer is called the corneal endothelium, and is made up of corneal endothelial cells that keep the cornea properly hydrated and transparent. In a condition called Fuchs Endothelial Dystrophy, these cells become damaged and start to deposit waste on their supporting layer. This causes swelling (edema) and can lead to scarring (fibrosis), making it difficult to see clearly.

Descemet Membrane Endothelial Keratoplasty (DMEK) is a surgery where these damaged corneal endothelial cells and the supporting layer are replaced with healthy ones from a donor. This procedure usually results in quick improvement in vision. However, in advanced cases of Fuchs Endothelial Dystrophy, vision recovery can be hindered by lingering haze in the cornea.

What problem/knowledge gap does it help address?

While DMEK offers rapid and significant visual improvement for many patients, some patients experience limited recovery due to persistent corneal haze and fibrosis. The lack of predictive tools makes it challenging to identify which patients are at risk for suboptimal outcomes. This study will address the unmet need for reliable indicators ahead of surgery to predict how well a patient’s vision will recover.

By investigating the correlation between corneal imaging signs before surgery and fibrosis and visual recovery after surgery, this research aims to fill a critical knowledge gap. Identifying these predictive biomarkers could enable earlier and more precise diagnosis of fibrosis, leading to timely and targeted interventions. Ultimately, this could improve the success rates of the surgery and enhance the quality of life for patients with advanced Fuchs Endothelial Dystrophy.

Aim of the research project

This study will explore whether certain signs seen in corneal images pre surgery can predict both development of fibrosis and how well a patient's vision will recover after surgery. If successful, this research could lead to earlier diagnosis of fibrosis, in turn guiding earlier treatment resulting in better outcomes for patients.

Potential impact on people with sight loss

This research has the potential to significantly impact people with or at risk of sight loss due to Fuchs Endothelial Dystrophy. The development of reliable and accessible imaging biomarkers of corneal endothelial dysfunction can help corneal surgeons stratify patients according to their risk of sight loss, guiding the decision of when and if to perform corneal transplant.

By identifying predictive biomarkers for fibrosis and visual recovery, clinicians can better select and manage patients for this surgery. Early diagnosis and timely intervention could prevent further vision deterioration, enhance surgical outcomes, and improve the quality of life for these patients.