OP-6 Vaccination against shingles and prevention of long-term ocular morbidity – a retrospective study of cost implications to the NHS

Background and Purpose Studies in patients with Fuchs endothelial dystrophy (FED) have noted associations between localised endothelial loss, increases in corneal densitometry and deposition of a collagen-rich fibrillar layer.We defined a specific imaging marker on anterior segment OCT (AS-OCT) that arises in the presence of deep stromal folds, known as posterior stromal ripples (PSR).We have shown that pre-operative PSR affects visual recovery after DMEK and are more likely to be present in more advanced disease.Our aim was to determine if PSR reflects ultrastructural fibrotic changes in Descemet's membrane-endothelium (DME).Methods DME complexes from patients with FED who had preoperative AS-OCT were identified and stained with hematoxylin-eosin, Periodic acid-Schiff as well as anti-CD34 and anti-alpha-smooth muscle actin (a-SMA) antibodies.Preoperative PSR were qualitatively graded and quantified using an algorithm trained to detect posterior corneal surface alterations.Results 52 patients have been included and to date 9 DME (including negative controls) have been analysed.H&E and PAS showed alterations of the DME complexes in all samples; however, the presence of anti-CD34 and anti-a-SMA was significantly more frequently present in samples from eyes showing pre-operative PSR (both p<0.05).Eyes with preoperative PSR had a lower final visual acuity compared to eyes without pre-PSR (mean [SD] 0.25 [0.1] vs. 0.05 [0.07] LogMAR).Conclusions Preoperative PSR reflects ultrastructural fibrotic changes along Descemet's membrane and is associated with a lower final visual acuity.This suggests that earlier intervention in patients with FED prior to the development of PSR is indicated.