Clinical course analysis following cataract surgery in patients with Fuchs’ endothelial corneal dystrophy using severity grading based on anterior segment optical coherence tomography.

Abstract

Purpose : To analyze clinical course following cataract surgery in patients with Fuchs’ endothelial corneal dystrophy (FECD) using severity grading based on anterior segment optical coherence tomography (AS-OCT).

Methods : 34 eyes of 27 patients with FECD who underwent cataract surgery in department of ophthalmology Osaka university hospital between 2009 August and 2017 December were retrospectively reviewed. Preoperative central corneal thickness (CCT) and severity grading was determined using AS-OCT: 0, no change; 1, mild edema; 2, moderate edema with posterior elevation; 3, severe edema with posterior irregular elevation. Patients with follow up period of less one year were excluded. Receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the additional diagnostic improvement by adding AS-OCT grading on to CCT for prediction of the need for keratoplasty during postoperative one year.

Results : Average age at the timing of cataract surgery was 70.2±8.2 years. 4 fames and 23 females were included. All cataract surgeries were performed successfully using soft shell technique without severe complication. Only cataract surgery was performed for all patients without combined keratopathy. 15 of 34 eyes (44.1%) underwent keratoplasty within postoperative one year: 1 of 12 eyes in grade0, 0 of 4 eyes in grade1, 4 of 8 eyes in grade2, 10 of 10 eyes in grade3 underwent keratoplasty. Keratoplasty was performed for 2 of 15 eyes in CCT less than 600um, 6 of 12 eyes in CCT from 600 to 700 um, 7 of 7 eyes in CCT more than 700um. Although the AUC using ROC curves by AS-OCT grading was superior to CCT (0.92 vs. 0.87), the difference was not significant (p=0.31). NRI was 0.21(p=0.19) when AS-OCT severity grading added on to CCT. IDI was 0.26 when AS-OCT severity grading was added on to CCT and it was statistically significant (p=0.00064).

Conclusions : It was suggested that AS-OCT based severity grading for FECD was useful providing additional information on CCT in predicting clinical course and need for keratoplasty following cataract surgery.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.