PHACOEMULSIFICATION ALONE OR COMBINED WITH DESCEMET´S STRIPPING WITHOUT ENDOTHELIAL KERATOPLASTY IN PATIENTS WITH CATARACT AND EARLY-STAGE CENTRAL FUCHS ENDOTHELIAL DYSTROPHY: A COMPARATIVE STUDY

To compare the efficacy of Descemet´s stripping without endothelial keratoplasty (DWEK) associated with phacoemulsification versus phacoemulsification alone in patients with moderate cataract and early-stage central Fuchs endothelial corneal dystrophy (FECD).

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

Retrospective, comparative, non-randomized study, including all patients with early-stage central FECD who were proposed to cataract surgery alone (group 1) or associated with a Descemet’s stripping only (group 2) at our ophthalmology department. Best-corrected visual acuity (logMAR BCVA), endothelial cell central count (ECC), central pachymetry, vision quality (Ocular Scatter Index-OSI- and Modular Transfer Function-MTF, HD Analyzer^TM) were evaluated 12 months after surgery. Time to achieve corneal transparency and the need for a corneal transplant were also compared. 

Fourty-four eyes were included: 21 were submitted to phacoemulsification alone (group 1) and 23 to cataract surgery associated with DWEK (group 2). Patients from group 1 were older (76.4±5.4 vs 68.7±9.1 years old, p=0.001). Although all patients had central confluent guttae, fifteen eyes from group 1 (71.4%) and 7 eyes from group 2 (30.4%) had countable central endothelial cells at baseline (p=0.007). Four eyes from group 1(19%) and 2 eyes from group 2 (8.7%) did not achieve corneal transparency and were submitted to an endothelial keratoplasty (p=0.403). Among those who achieve transparency, eyes from group 2 took longer to get a clear cornea (3.20±1.15 vs 0.97±0.96 months, p<0.001). BCVA was significantly improved in both groups 12 months after surgery, but final BCVA was higher in group 1 (logMAR 0.07±0.07 vs 0.17±0.13, p=0.007). ECC was similar in both groups (1388.8±337.7 and 1445.1±321.1 cells/mm², respectively- p=0.614). Three out of 17 eyes (17.6%) from group 1 did not have countable endothelial cells, while all patients from group 2 had countable cells (p=0.081). There was no difference regarding pachymetry (516.1±55.7 and 528.8±36.8, respectively-p=0.419). OSI and MTF values were similar between groups (p>0.05). 

Although the results were not statistically significant, the need for an endothelial transplant was higher when cataract surgery was performed alone. In the other hand, eyes submitted to phacoemulsification achieved faster corneal transparency and better BCVA, which may be explained by the better endothelial cell count at baseline in this group. In addition, no differences were found regarding final ECC, pachymetry and vision quality parameters. In conclusion, both procedures are suitable and effective for selected patients with cataract and early-stage central FECD, delaying or avoiding corneal transplant in eyes with central FECD.