Predictive Biomarkers For The Prognosis Of Phacoemulsification And Posterior Chamber Intraocular Lens Implantation In Fuchs Endothelial Corneal Dystrophy

To investigate the clinical outcomes following phacoemulsification and posterior chamber intraocular lens implantation (PE & PCL) in patients with Fuchs endothelial corneal dystrophy (FECD) and to identify biomarkers that could predict the need for Descemet Membrane Endothelial Keratoplasty (DMEK) or limited visual improvement following PE & PCL in FECD patients.

This is a retrospective study of patients with FECD who underwent PE & PCL from January 1, 2006 to December 31, 2023, at the Department of Ophthalmology in Seoul National University Hospital, a tertiary hospital in Seoul, Korea. Medical records of 221 eyes from 143 consecutive FECD patients who underwent PE & PCL were reviewed. Eyes with previous or concurrent ocular surgeries, or those with other ocular diseases affecting vision, were excluded.

A total of 180 eyes from 112 patients were included in the study. Demographic information and ocular biometric characteristics such as axial length, lens thickness, white-to-white distance (WTW), and nuclear color grade; best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV) and hexagonality were collected. Risk factors were analyzed for three outcomes: 1) the need for sequential DMEK, 2) postoperative BCVA < 0.5, and 3) postoperative increase in CCT of > 5%, using uni- and multi-variate regression analyses and receiver operating characteristic (ROC) curves. The cut-off value maximizing sensitivity and specificity of ROC was calculated.

At postoperative 1 month, logMAR BCVA improved from 0.51 to 0.20, mean CCT increased by 2.6%, from 567 μm to 583 μm, and ECD decreased by 14.6%, from 1949 cells/mm² to 1663 cells/mm² (all p < 0.05). Multivariate analysis for the need of DMEK (n = 10) revealed CCT as a risk factor with odds ratio (OR) of 1.58 (p < 0.05). CCT value of 620 μm predicted the requirement for DMEK with 100% sensitivity and 91% specificity. Predictive factors for BCVA < 0.5 included CCT and ECD (OR 1.22; OR 0.82, all p < 0.05) with cut-off values of 592 μm (88% specificity, 73% sensitivity), and 1050 cells/mm² (80% specificity, 60% sensitivity), respectively. Risk factors for > 5% increase in CCT included WTW (OR 0.14, p < 0.05).  

PE & PCL in FECD significantly improved visual acuity, while changes in ECD and CCT were comparable to those in normal eyes undergoing cataract surgery, as previously reported. As a critical risk factor, preoperative CCT value can be used to predict the need for a sequential DMEK and limited improvement in visual acuity. Narrower WTW may be related to a greater increase in CCT in FECD patients.