Incidence of Corneal Transplantation in Fuchs Endothelial Dystrophy after Cataract Surgery
Authors: C. Maya Tong1, David J. A. Plemel2, Stanley Chan2. 1University of Montreal, 2University of Alberta.
Author Disclosure Block: C. Tong: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Dompe. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisor. D.J.A. Plemel: None. S. Chan: None.
Title: Incidence of Corneal Transplantation in Fuchs Endothelial Dystrophy after Cataract Surgery
Purpose: The purpose of this study was to investigate the incidence of Fuchs endothelial dystrophy (FED) in patients referred for routine cataract surgery in Northern Alberta and to determine the incidence of secondary corneal transplantation after cataract surgery in eyes that had otherwise asymptomatic FED.
Study Design: Retrospective case series
Methods: Patients referred to a single surgeon for cataract surgery between May 1, 2013 and December 31, 2016 were reviewed. Specular microscopy and clinical exam was used for every patient to determine the incidence of FED. The incidence of corneal transplantation after cataract surgery in asymptomatic FED was identified by including all eyes that had cataract surgery without concurrent corneal surgery by December 31, 2017 and reviewing Alberta transplant records ending January 31, 2021.
Results: 3295 patients were referred for cataract surgery over the 44-month study period. 155 patients were identified to have FED (4.7%). Cataract and FED was identified in 260 eyes. 19 of these eyes were excluded: 15 did not have cataract surgery in the study period, 1 had combined cataract and retina surgery and 3 underwent combined cataract and endothelial keratoplasty (EK). 241 eyes met study criteria. The average preoperative visual acuity was logmar 0.29 (±0.21). Preoperatively, 88 (36.5%) eyes had 1+ guttae, 85 (35.3%) eyes had 2+ guttae, 37 (15.4%) eyes had 3+ guttae, and 31 (12.9%) eyes had 4+ guttae. Average preoperative endothelial cell density was 2108.4 ±440.7 cells/mm2 and the average central pachymetry was 530.1 ±43.4um. The average cumulative dispersed energy (CDE) was 7.89 ± 6.01. Over the following two years, 3 eyes (1.2%) went on to require EK for endothelial failure after cataract surgery.
Conclusions: The incidence of FED is low in the population being referred for cataract surgery. There is a very low proportion of eyes with asymptomatic FED that go on to require EK, suggesting that cataract surgery followed by EK when necessary is an appropriate management algorithm in eyes with asymptomatic FED.