Outcomes Of Fuchs’ Endothelial Corneal Dystrophy Patients Undergoing Conventional Phacoemulsification Surgery With Soft-Shell Technique

To evaluate the rates of corneal decompensation in Fuchs' endothelial corneal dystrophy (FECD) patients undergoing conventional phacoemulsification surgery (CPS) with soft-shell technique (SST).

This retrospective study included all eyes with FECD who underwent cataract surgery with soft shell technique at James Cook University Hospital between 2017 and 2020.

All cases were performed by a single surgeon using CPS with SST using a dispersive Ophthalmic Viscoelastic Devices (OVD) (i.e. DuoVisc OVD). Central Corneal Thickness (CCT) was measured preoperatively and postoperatively by Ultrasound Pachymetry or Anterior Segment OCT (AS-OCT). A minimum follow-up of 1 month was required. Data including age, ocular comorbidities preoperative Best Corrected Visual Acuity (BCVA), preoperative CCT, presence of corneal oedema preoperatively, postoperative BCVA (at 3 months, 6 months and 12 months), postoperative CCT, presence of postoperative corneal oedema (CO) requiring corneal transplant and duration of follow-up were collected.

A total of 21 eyes of 11 patients were included. Mean age was 83 years old (range 70-92). Baseline mean BCVA was 0.31 LogMAR (range 0.18-0.60). Mean preoperative CCT was 576 μm (range 501-674 μm). Four eyes had CCT >600μm and 2 eyes had CCT >640μm. None of the eyes had preoperative CO. Mean postoperative BCVA after CPS with SST was 0.15, 0.20 and 0.07 LogMAR (-0.18 – 0.18) at 3, 6 and 12 months, respectively. Mean CCT at final follow-up visit was 565μm (range 486-638μm). None of the eyes developed clinically significant postoperative corneal decompensation requiring corneal transplant. Two patients were subsequently listed for Descemet Membrane Endothelial Keratoplasty (DMEK) surgery to improve the visual outcome.

In the present study, none of our patients developed corneal decompensation requiring corneal transplant, including patients with CCT >640μm. Conventional phacoemulsification surgery with soft-shell technique was associated with favourable visual outcome in FECD eyes.