Corneal Edema and Opacification
Publication Date: February 12, 2024
Last Updated: February 16, 2024
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
The impact of corneal edema on activities of daily living―particularly those influenced by ambient light conditions at home, work, and during leisure activities―is often under appreciated. Standard measurement of visual acuity does not give a true representation of the patient's functional vision. (, , )
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A refraction over a rigid gas-permeable (RGP) or scleral contact lens can be very helpful in determining visual loss is due to a corneal surface irregularity. (, , )
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Endothelial function is best evaluated by casual history and examination with slit-lamp biomicroscopy. When diffuse endothelial guttae are present on slit-lamp biomicroscopy examination, serial pachymetric measurements and tomographic evaluation may help monitor endothelial function. Specular microscopy is not a direct measure of endothelial function or functional reserve. Corneal topography revealing irregular isopachs, nasal displacement of the thinnest cornea, and posterior depression may help predict Fuchs dystrophy patients at greater risk of endothelial decompensation. (, , )
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If corneal decompensation is likely to occur in the near future, the surgeon should consider modifying the intraocular lens (IOL) power calculation to adjust for changes likely to be induced by future endothelial keratoplasty. This often involves a hyperopic shift after Descemet's stripping automated endothelial keratoplasty (DSAEK) and less of a hyperopic shift with Descemet's membrane endothelial keratoplasty (DMEK). A full discussion with the cataract and Fuchs dystrophy patient about IOL-power selection and the added risks of subsequent corneal decompensation is very important and helps to shape the patient's expectations with respect to their condition and the surgery. (, , )
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Endothelial keratoplasty (EK) has supplanted penetrating keratoplasty (PK) as the procedure of choice in cases of endothelial failure in the absence of corneal scarring because patients achieve more rapid visual rehabilitation and reduced risk of immune-mediated rejection of the transplanted tissue and less induced astigmatism. (, , )
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Many corneal opacities start as persistent, nonhealing epithelial defects that opacify as a result of infection, inflammation, tissue breakdown, and/or scarring. Nerve growth factor has been shown to be effective in treating nonhealing epithelial defects in the setting of neurotrophic keratopathy. (, , )
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Title
Corneal Edema and Opacification
Authoring Organization
American Academy of Ophthalmology
Publication Month/Year
February 12, 2024
Last Updated Month/Year
February 19, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
Assess the degree of vision loss. Evaluate the degree of functional impairment and its effect on the patient’s activities of daily living. Identify the underlying ocular condition responsible for the corneal edema or opacification. Assess the potential for progression of the disorder, development of discomfort, and/or improvement of vision. Determine which optical, medical, or surgical treatment alternative is most appropriate.
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Operating and recovery room, Outpatient
Intended Users
Optometrist, optician, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D015715 - Corneal Edema, D003316 - Corneal Diseases
Keywords
corneal edema, Opacification, ocular diseases
Source Citation
Mian SI, Viriya ET, Ahmad S, Amescua G, Cheung AY, Choi DS, Jhanji V, Lin A, Rhee MK, Mah FS, Varu DM; American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Panel. Corneal Edema and Opacification Preferred Practice Pattern®. Ophthalmology. 2024 Feb 12:S0161-6420(24)00011-3. doi: 10.1016/j.ophtha.2023.12.039. Epub ahead of print. PMID: 38349302.
Methodology
Number of Source Documents
284
Literature Search Start Date
March 3, 2022
Literature Search End Date
June 7, 2023