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Boon Lin Teh, Ana Luiza Mylla Boso, Yun Lin Ang, Panagiota Papadakou, Nikolaos Tzoumas, Francisco C Figueiredo; Outcomes of conventional phacoemulsification surgery in Fuchs’ endothelial dystrophy. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2761 – A0250.
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© ARVO (1962-2015); The Authors (2016-present)
Fuchs’ endothelial corneal dystrophy (FECD) is the most common corneal endothelial dystrophy and a major cause of visual impairment. FECD patients are at increased risk of endothelial cell density (ECD) loss during cataract surgery, requiring careful surgical consideration. We examine the predictive factors for corneal decompensation and the proportion of FECD patients requiring corneal transplant following conventional phacoemulsification surgery.
We retrospectively included all patients with FECD undergoing phacoemulsification and intraocular lens implantation by a single surgeon (FF) during 2015–2021 in a UK tertiary hospital, all conducted with soft-shell technique using DuoVisc®. We collected best-corrected visual acuity (BCVA), specular microscopy, and pachymetry measurements pre- and post-operatively, as well as complications and need for further corneal transplant. We excluded patients without pre- and post-operative specular microscopy measurements and those with follow-up of less than 2 months.
64 eyes of 51 patients were included. The mean age was 73 years (SD=9), 59% female. Median follow-up was 32 months (IQR=18). 13 (20.3%) eyes required Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) after cataract surgery, nine planned on listing and four unplanned. Median time between operations was 3 months (IQR=4). Of the 51 eyes not needing DSAEK, there was a significant change in mean BCVA (−0.13 logMAR, P=0.01) and central corneal thickness (CCT; +19.9μm, P<0.001) following cataract surgery. There was no significant change in ECD (−14%, P=0.16), hexagonality (−3%, P=0.23), or mean cell area (P=0.30). Using multilevel logistic regression adjusted for age, sex, and inter-eye correlation, we find that pre-operative CCT significantly predicts the risk of corneal decompensation (OR 1.01/μm, 95% CI 1.00–1.03, P=0.02) and need for corneal transplant post-cataract surgery (OR 1.04/μm, 95% CI 1.02–1.08, P=0.002). Kaplan-Meier analyses identify pre-operative CCT as a predictor of time-to-transplantation (P<0.001) with an optimal cutpoint value of 591μm.
Conventional phacoemulsification surgery with soft-shell technique has favourable visual outcomes in FECD. Careful counselling of FECD patients before cataract surgery is important with high pre-operative CCT being a significant risk factor for post-operative corneal decompensation and need for corneal transplantation.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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