Corneal guttata: a comparative clinical and specular micrographic study

Background The relationship between corneal guttata and Fuchs' endothelial dystrophy is unclear, with the result that the clinical differentiation of the two conditions is often made on the basis of the presence or absence of symptoms. Methods In this study the authors compare the clinical and specular micrographic findings, as recorded from 20 patients noted to have biomicroscopic clinical findings consistent with corneal guttata or early Fuchs' endothelial dystrophy. Results Results confirm the increased prevalence of conceal findings in elderly women. The topographical distribution of guttata, across the posterior corneal surface, as observed clinically was confirmed specular micrographically (r(s) = 0.55, p = 0.01). Increased numbers of guttata correlated with a statistically significant reduction in the endothelial cell counts recorded from the midperipheral cornea (us = 0.49, p = 0.02). The relationship between the presence of guttata and a reduction in cellular hexagonality or an increase in polymegethism failed to reach a statistically significant level. Pigment deposits adherent to the posterior endothelial surface were also noted in all but one of the eyes examined. Conclusions The authors advocate the use of a grading scale, developed from specular micrographs taken during the course of the study, to assist in the clinical classification of conceal guttata and pre-clinical Fuchs' dystrophy. The authors also recommend specular microscopy as a tool capable of differentiating conceal guttata from pigment deposits in even the most severely affected cases.