Descemet’S Stripping Without Endothelial Keratoplasty In Early-Stage Central Fuchs Endothelial Dystrophy: Long-Term Results

To report long-term results of Descemet membrane stripping without endothelial keratoplasty (DWEK) associated with phacoemulsification in patients with early-stage central Fuchs endothelial dystrophy (FED). 

Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal. 

Retrospective study, including all patients submitted to DWEK associated with cataract surgery with a minimum follow-up of 24 months. Included patients had central confluent guttata confirmed with specular microscopy, a clear peripheral endothelium (with a peripheral endothelial count >1500 cells/mm²) and a central pachymetry < 600μm.

The main endpoints were the presence of a clear cornea and time that was needed to achieve a clear cornea, best corrected visual acuity (BCVA) in logMAR, refractive outcome (spherical equivalent and cylinder values), endothelium central cell count (ECC), central corneal thickness (CCT), and presence of tomographic changes (namely the presence of irregular astigmatism) at the end of follow-up. 

A total of 22 eyes from 15 subjects were included with a mean follow-up of 40.8±10.5 months. At baseline, only 6 eyes had countable endothelial central cells (mean 1138±190 cells/mm²) and mean CCT was 536±34 mm. 

A total of 20 cases (90.9%) achieved good corneal transparency after 3.2±1.1 months after surgery. There was a significant improvement in logMAR BCVA compared to baseline (0.13±0.10 vs 0.48±0.24, respectively, p<0.001). Endothelium central repopulation was observed in all successful cases. ECC 12 months after DWEK was 1449±344 cells/mm² and 1393±450 cells/mm² in the end of follow-up, with no significant decrease between this period (p=0.081). Only 2 eyes (9.1%) did not achieve a clear cornea and needed an endothelial keratoplasty.

According to our results, DWEK associated with phacoemulsification is a safe and effective procedure, allowing high rates of corneal transparency in cases of early-stage central FED with mild to moderate cataract. This seems to be a promising technique in selected cases, delaying or avoiding endothelial transplantation.