Characteristics of the corneal endothelium in elderly adults with high myopia

Abstract Background: To investigate the characteristics of the corneal endothelium in elderly patients with high myopia. Methods: We assessed the corneal endothelial characteristics of 1065 elderly patients (549 highly myopic and 516 control eyes) by non-contact specular microscopy in this cross-sectional study. Eyes with suspected Fuchs endothelial corneal dystrophy (FECD) were further confirmed with slit-lamp and confocal microscopy. Results: The central endothelial cell density (ECD) and the coefficient of variation (CV) were significantly greater (P = 0.001 and P= 0.002, respectively), whereas the average cell area (AVG) and percent of hexagonality (HEX) were significantly lower (P = 0.014 and P< 0.001, respectively) in highly myopic eyes than in control eyes. After adjusting for age and gender, axial length (AL) was positively correlated with ECD and CV (r = 0.130, P< 0.001 and r = 0.113, P < 0.001, respectively), and negatively correlated with AVG and HEX (r = −0.105, P = 0.001 and r = −0.204, P < 0.001, respectively). FECD was found in 4.92% of highly myopic eyes and 3.29% of control eyes. Although the distribution of clinical grade in FECD was not significantly different between highly myopic and control eyes (P = 0.106), more advanced FECD patients were seen in the highly myopic eyes (P= 0.036). Conclusion: Longer AL led to increased corneal ECD, and greater endothelial pleomorphism and polymegethism in elderly patients. The incidence and severity of FECD were also greater in highly myopic eyes.