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Elizabeth Esparaz, Hyunjoo Lee; Cataract Surgery in African American Patients with Fuchs Endothelial Corneal Dystrophy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5263.
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© ARVO (1962-2015); The Authors (2016-present)
Cataract surgery in patients with Fuchs’ endothelial corneal dystrophy (FECD) poses the risk irreversible corneal edema post-operatively. Central corneal thickness (CCT) greater than 640 microns has been shown to be a predictor for need of additional corneal transplantation in FECD patients who undergo cataract surgery. This conclusion is largely based on studies of Caucasian subjects. African American patients have a lower average CCT than Caucasian patients, suggesting that a lower threshold for combined corneal and cataract surgery may be warranted. Our aim was to relate the pre-operative CCT to the outcomes of cataract surgery in our patients with FECD, and to compare these results between our African American and Caucasian patients.
We received IRB approval to conduct a retrospective review of all patients with FECD who had undergone cataract surgery at Boston Medical Center, collecting the following data: patient age, sex, race, visual acuity at various time points, central corneal thickness, cataract description, intra-operative complications, and length of follow up. The average pre-operative CCT, and the pre-operative and post-operative visual acuity, were compared between racial groups.
From 2003-2014, 29 patients with FECD underwent cataract surgery. Of these, 25 eyes had central corneal thickness data; 44% were Caucasian, 40% were African American, and 16% were Hispanic. No eyes that had cataract surgery alone progressed to corneal transplantation. The average pre-operative CCT for African Americans was 553 microns, which was significantly lower than the average pre-operative CCT for Caucasian patients (586 microns), p = 0.018. The average post-operative best-corrected visual acuity in African Americans was 0.213 log mar, and there was no statistically significant difference in visual acuity between African Americans and Caucasian patients.
African American patients with FECD had a statistically lower average pre-operative CCT than Caucasian patients, but had similar post-operative cataract surgery outcomes. None of the African American FECD patient eyes with pre-op CCT less than 600 µm progressed to needing corneal transplantation, suggesting that at least a cut-off of 600 µm may be safely used to determine need for corneal surgery at the time of cataract surgery in these cases, despite the overall average lower CCT in the African American population.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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