Gas stress test for assessment of corneal endothelial function

Abstract Purpose: This study was undertaken to evaluate the endothelial pump function by monitoring both corneal swelling response under hypoxia and dehydration response following hypoxia in vivo. Methods: Humidified nitrogen gas was used to obtain corneal swelling, and humidified gas mixed with oxygen and nitrogen was used for corneal dehydration. First, in 6 young volunteers, we investigated the most suitable oxygen level for evaluating pump function by changing oxygen levels. Then, with the optimal oxygen level, we attempted to evaluate pump function in 53 normal subjects, 5 Fuchs' dystrophy patients, and 3 iridocorneal endothelial syndrome (ICE) patients. Results: Swelling rate showed similar values regardless of age, but both dehydration rate and swelling rate plus dehydration rate decreased with aging. The swelling rate of 5 guttata corneas was significantly higher than that of age-matched control corneas. In contrast, dehydration rate markedly decreased in guttata corneas, while the swelling rate plus dehydration rate of guttata corneas was comparable to that of age-matched corneas. In the 3 ICE corneas, however, swelling rate, dehydration rate, and swelling rate plus dehydration rate were markedly lower than those of both the fellow corneas and the age-matched control corneas. Conclusion: These observations lead us to conclude that in order to evaluate pump function, it is necessary to monitor not only dehydration response following hypoxia but also swelling response under hypoxia.