Anterior keratocyte depletion in fuchs endothelial dystrophy

Objective: To determine if keratocyte populations are different in corneas with Fuchs dystrophy compared with control corneas. Methods: Eleven corneas excised during penetrating keratoplasty for Fuchs dystrophy and 5 control corneas of eyes enucleated for choroidal melanoma were examined using light microscopy. Twenty control corneas age-matched to the corneas with Fuchs dystrophy were examined using confocal microscopy in vivo. The number of keratocytes in a full-thickness column of central stroma with frontal area of 1 mm2, determined using histologic and confocal methods, was compared between corneas with Fuchs dystrophy and controls. Results: By histology, the mean (SD) number of cells in a full-thickness column of stroma in Fuchs dystrophy (12 215[1394] cells) was less than in control corneas (15 628[710] cells; P < .001). The mean (SD) number of keratocytes in the anterior 10% of the stroma of corneas with Fuchs dystrophy (682[274] cells) was less than in the control corneas measured using histology (1858[404] cells; P < .001) and confocal microscopy (1481[397] cells; P < .001). Conclusions: Keratocytes are depleted by 54% to 63% in the anterior 10% of the stroma of corneas that require penetrating keratoplasty for Fuchs dystrophy. Keratocyte loss might contribute to anterior stromal changes that persist and degrade vision after endothelial keratoplasty.