The relationship between corneal subbasal nerve density and corneal sensitivity in patients with Fuchs endothelial corneal dystrophy

Purpose: The aim of this study was to investigate the association between alterations in corneal subbasal nerve plexus and tactile corneal sensitivity in patients with Fuchs' endothelial corneal dystrophy (FECD). Methods: This retrospective, cross-sectional study included 24 (10 M/14 F) patients with FECD and 25 age- and sex-matched (10 M/15 F) healthy subjects as controls. Subjects with FECD were classified as having early (grades 1 and 2) and late (grades 3 and 4) disease. All subjects underwent central corneal tactile sensitivity measurements with the Cochet-Bonnet esthesiometer (Luneau Ophthalmologie, Chartres, France) and subbasal nerve density evaluation using in vivo confocal microscopy (IVCM). Association between corneal nerve plexus density and corneal sensitivity alterations were evaluated using the Mann-Whitney U test and the Spearman correlation test. Results: Compared to healthy subjects (mean age = 60.4 +/- 7.5 years), patients with FECD (mean age = 60.6 +/- 8.0 years) had worse central corneal sensitivity scores (5.9 +/- 0.1 cm vs. 4.2 +/- 0.8 cm; P < 0.001), reduced corneal nerve fibers (3.4 +/- 1.3 nerves/frame vs. 5.0 +/- 0.9 nerves/frame; P < 0.001) and lower corneal subbasal nerve plexus densities (2229.4 +/- 364.3 mu m/mm(2) vs. 1901.6 +/- 486.8 mu m/mm(2); P = 0.050). Patients with late stage FECD demonstrated lower subbasal nerve densities as compared to those with early disease (2204.3 +/- 313.1 mu m/mm(2) (range = 1523-2552 mu m/mm(2)); 1397.1 +/- 227.4 mu m/mm(2) (range = 1120-1834 mu m/mm(2)); P < 0.001). In the FECD group, subbasal nerve density was found to be directly correlated with corneal sensitivity scores (r = 0.457, P = 0.025). Conclusion: Progressive loss of the corneal subbasal nerve plexus appears to be a consistent feature of FECD. Reduction of the corneal nerve plexus parallels the decrease in corneal sensitivity in this patient population.