Detection of subclinical corneal edema in fuchs' dystrophy using galilei tomography.

PURPOSE: To evaluate the efficacy of the Galilei device in detecting and distinguishing subclinical corneal edema in patients with Fuchs Endothelial Dystrophy (FED). METHODS: We divided the patients into three groups based on their FED Characteristics. FED patients with prominent clinical edema, FED patients with subclinical edema (transparent corneas with CCT > 550 μm) and FED patients with no edema (transparent corneas with CCT < 550 μm). We also included a group of healthy patients as a control. We evaluated pachymetry and posterior depression maps, recording the presence of three main parameters for each patient: irregular isopachs, displacement of the thinnest point, and focal posterior corneal surface depression. Additionally, we modified the criteria for these parameters to enhance the detection rates of subclinical edema. RESULTS: This study included 55 eyes from 30 patients with FED (mean age, 69.97 ± 10.45 years) and 30 eyes from 18 patients without FED (mean age, 26.83 ± 6.80 years). All three parameters were detected in 95.6% of eyes with clinical edema, while 83.3% of healthy corneas did not show any parameter, and the remaining 16.7% had only a single parameter present. Moreover, 75% of eyes in the subclinical edema group showed all three parameters, and 25% had at least two parameters present. The progression in FED severity and edema correlated with an increase in the number of observed parameters. Modification of the parameters improved the diagnostic efficacy, with the most accurate combination being the modified displacement of the thinnest point with focal posterior surface depression, achieving 73.3% sensitivity, 80% specificity, with an AUC of 0.767. CONCLUSION: Our results show that Galilei can assist in the detection of subclinical edema in patients with FED. We recommend using Galilei as a tool for assessing subclinical edema in patients with clear corneas who present with FED characteristics on a specular microscope. It can assist physicians in evaluating the extent of the condition and the next steps in the management plan.