The Impact Of Overlooked Fuchs Endothelial Corneal Dystrophy: Postoperative Results Following Intraocular Interventions

To evaluate postoperative outcomes in patients with previously unrecognized Fuchs endothelial corneal dystrophy (FECD) following intraocular surgery and to identify clinical, endothelial, and tomographic features associated with delayed diagnosis and corneal decompensation.

The study was conducted by an experienced cornea specialist at the Cornea and Ocular Surface Diseases Unit of the Department of Ophthalmology, Balikesir University.

This retrospective observational study included patients who underwent intraocular surgery without a preoperative diagnosis of FECD and were subsequently referred for persistent postoperative corneal edema. Demographic data, surgical history, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were recorded. Endothelial cell parameters were assessed using non-contact specular microscopy, and corneal morphology was evaluated with Scheimpflug-based tomography, including pachymetric distribution, posterior corneal elevation, and higher-order aberrations.

Forty-five eyes of 39 patients (mean age 69.8 ± 10.5 years; 86% female) were analyzed. Phacoemulsification was the most common prior procedure (91.1%), with a mean interval of 33.4 ± 24.1 months before FECD diagnosis. Mean BCVA increased from 0.18 ± 0.07 to 0.36 ± 0.19 (p = 0.090), while IOP remained stable. Specular microscopy showed reduced endothelial cell density (1146.7 ± 467.7 cells/mm²), increased polymegathism (CV:33.8 ± 14.9%), and decreased hexagonality (17.5 ± 29.9%).Mean CCT measured 588.0 ± 83.6 µm (specular) and 636.0 ± 105.5 µm (tomography). Tomography revealed increased CCT, loss of isopachs (90%),posterior elevation (66.7%), and elevated posterior HOAs (3.93 ± 4.01 µm RMS). Endothelial keratoplasty was recommended in 84.4%.

Previously unrecognized FECD may predispose patients to postoperative corneal decompensation after intraocular surgery, and comprehensive endothelial and tomographic assessment may facilitate earlier diagnosis, improved risk stratification, and reduced postoperative corneal morbidity.