Purpose: A central collagen-rich subendothelial fibrillar layer (FL) correlates with areas of accentuated loss of corneal endothelial cells in advanced Fuchs endothelial corneal dystrophy (FECD). The present study sought to investigate whether the FL may be visualized by en face Scheimpflug backscatter imaging in vivo.

Design: Retrospective analysis of a prospective observational case series.

Methods: A total of 34 eyes (34 subjects) undergoing Descemet membrane endothelial keratoplasty (DMEK) surgery with preoperative high-quality Scheimpflug backscatter imaging data were included. The Descemet endothelium complex (DEC) was retrieved during DMEK surgery, and immunofluorescence staining was performed for collagens I, III, and IV. The FL morphology in en face Scheimpflug backscatter and immunofluorescence imaging was compared and agreement of FL parameters was analyzed using intraclass correlation coefficients (ICC) and Bland−Altman plots.

Results: Scheimpflug backscatter imaging delineated the FL in 26 eyes and was FL negative in 8 eyes with deviation compared to immunofluorescence in 1 case and good agreement of morphology characteristics. Horizontal caliper diameter ± SD was 4.84 ± 0.85 mm, vertical caliper diameter was 3.92 ± 0.78 mm, maximum caliper diameter was 5.12 ± 0.82 mm, and surface area was 12.43 ± 4.74 mm². Compared to immunofluorescence imaging, mean difference (95% limits of agreement) and intraclass correlation coefficients were for horizontal caliper diameter 0.13 mm (−0.81 to 1.1 mm) and 0.88, vertical caliper diameter 0.23 mm (−0.76 to 1.2 mm) and 0.81, maximum caliper diameter 0.06 mm (−1.1 to 1.2 mm) and 0.86, and surface area 1.4 mm² (−3.9 to 6.7 mm²) and 0.85.

Conclusions: Scheimpflug backscatter imaging facilitates visualization of the FL in advanced FECD eyes, offering the potential to identify particularly diseased areas of the FECD endothelium in vivo.

目的：在晚期 Fuchs 角膜内皮营养不良 (FECD) 中，中央富含胶原蛋白的内皮下纤维层 (FL) 与角膜内皮细胞严重丢失的区域相关。本研究旨在调查 FL 是否可以通过正面 Scheimpflug 后向散射成像在体内进行可视化。

设计：前瞻性观察病例系列的回顾性分析。

方法：共有 34 只眼（34 名受试者）接受后弹力膜内皮角膜移植术（DMEK）手术，术前具有高质量的 Scheimpflug 反向散射成像数据。在 DMEK 手术期间取回后弹力内皮复合体 (DEC)，并对胶原 I、III 和 IV 进行免疫荧光染色。比较 en face Scheimpflug 反向散射和免疫荧光成像中的 FL 形态，并使用组内相关系数 (ICC) 和 Bland-Altman 图分析 FL 参数的一致性。

结果： Scheimpflug后向散射成像26眼勾画出FL，8眼FL阴性，1例与免疫荧光相比有偏差，形态特征吻合良好。水平卡尺直径±SD为4.84±0.85 mm，垂直卡尺直径为3.92±0.78 mm，最大卡尺直径为5.12±0.82 mm，表面积为12.43±4.74 mm ²。与免疫荧光成像相比，水平卡尺直径 0.13 毫米（-0.81 至 1.1 毫米）和 0.88、垂直卡尺直径 0.23 毫米（-0.76 至 1.2 毫米）和 0.81 的平均差（95% 的一致性限制）和组内相关系数，最大卡尺直径 0.06 mm（-1.1 至 1.2 mm）和 0.86，表面积 1.4 mm ²（-3.9 至 6.7 mm ²) 和 0.85。

结论： Scheimpflug 反向散射成像有助于在高级 FECD 眼中观察 FL，提供了在体内识别 FECD 内皮特别患病区域的潜力。