Recovery of Subbasal Nerve Density in Patients With Fuchs Endothelial Corneal Dystrophy After Descemet Membrane Endothelial Keratoplasty in Correlation to PROMs.

PURPOSE: The aim of this study was to examine changes in corneal sensitivity and subbasal nerve density in eyes with Fuchs endothelial corneal dystrophy (FECD) before and after Descemet membrane endothelial keratoplasty (DMEK). METHODS: This prospective observational study included 46 eyes of 46 patients with FECD undergoing DMEK surgery at Charité-Universitätsmedizin Berlin. Subbasal nerve plexus (SBP) was measured by in vivo corneal confocal microscopy and corneal sensitivity by Cochet-Bonnet esthesiometry preoperatively, 3, and 12 months postoperatively. Five images were analyzed for nerve fiber density (CNFD), branch density (CNBD), nerve fiber length (CNFL), corneal nerve tortuosity (CNTB), and corneal cell density (CD) using CCMetrics and HSA STUDY software. Patient-related outcomes included the ocular surface disease index questionnaire (OSDI) and visual function by Visual Function Questionnaire NEI-VFQ. RESULTS: Best-corrected visual acuity improved over time (preoperative 0.44 ± 0.26 LogMAR, after 12 months 0.21 ± 0.30 LogMAR, P < 0.001). Corneal sensitivity recovered to near preoperative levels (preoperative 0.67 ± 0.31 g/mm2, after 12 months 0.66 ± 0.41 g/mm2, P = 0.987). SBP parameters decreased significantly including CNFD (preoperative 16.80 ± 6.57 no/mm2, after 12 months 14.68 ± 6.19 no/mm2, P = 0.025), CNBD (preoperative 38.81 ± 28.12 no/mm2, after 12 months 28.39 ± 18.36 no/mm2, P = 0.022), CNFL (preoperative 11.62 ± 5.11 mm/mm2, after 12 months 9.82 ± 4.11 mm/mm2, P = 0.022), CD (preoperative 35.67 ± 26.35 no/mm2, after 12 months 4.46 ± 10.51 no/mm2, P < 0.001), whereas CNTB increased (preoperative 14.51 ± 4.47, after 12 months 22.70 ± 14.44, P = 0.063). OSDI improved significantly (preoperative 42.24 ± 17.75, after 12 months 35.36 ± 18.68, P = 0.029). CONCLUSIONS: This prospective study demonstrates that DMEK leads to near preoperative recovery of corneal nerve density. Furthermore, significant improvement in dry eye symptoms can be detected, and enhanced quality of life in patients with FECD, although corneal nerve density does not fully return to levels of healthy individuals.