**7.3. Monitoring surgical patients**

*A Practical Guide to Clinical Application of OCT in Ophthalmology*

**7.1 Fuchs' endothelial corneal dystrophy**

**7.2 Detection of corneal graft rejection**

**(En/DM)**

**7. Corneal pathology within endothelium/Descemet membrane complex** 

Abou Shousha et al. published UHR-OCT characteristics of Fuchs' dystrophy patients. Descemet membrane appeared as a thickened band with two opaque lines; the anterior line was smooth while the posterior line was wavy and irregular with areas of focal thickening (**Figure 5**) [9]. Descemet membrane thickness was increased in Fuchs' dystrophy patients compared with normal subjects [9].

Basement membrane thickening has previously been established as evidence of graft rejection in solid organs transplantation [78, 79]. Abou Shousha et al. demonstrated that thickening of the En/DM also occurs in corneal graft rejection (**Figure 6**) [80]. This study was limited by the resolution of HD-OCT as it was not possible to differentiate

*A prototypical cross-sectional UHR-OCT image of a full thickness corneal transplant with active rejection: Descemet membrane appeared as a thickened band with two hyper-reflective lines; the anterior line (yellow arrow) was smooth while the posterior line (white arrow) was wavy, broader with occasional nodular* 

*A prototypical cross-sectional UHR-OCT image of a human cornea with Fuchs' endothelial dystrophy; sub-epithelial vesicle (red star), Descemet membrane appeared as a thickened band with two opaque lines; the anterior line (yellow arrow) was smooth while the posterior line (white arrow) was wavy and irregular with* 

**12**

**Figure 6.**

**Figure 5.**

*areas of focal thickening.*

*excrescences.*

Transient corneal edema seen after phacoemulsification was caused by changes in the central corneal thickness, stroma and En/DM complex. There were no significant post-operative changes in Bowman's layer or epithelium. Pre-operative En/DM thickness may indicate the integrity of the endothelium and could be used to predict endothelial cell loss after phacoemulsification [81].
