Author’s Disclosure Block: Jack Mouhanna, none; Guillermo Rocha, none

Abstract Body
Purpose: Post-operative corneal edema is an important consideration in patients with Fuchs corneal endothelial dystrophy (FECD) undergoing cataract surgery. Decision-making for combined cataract surgery and endothelial keratoplasty in cases with early FECD is particularly challenging given the lack of reliable prognostic indicators. This study aims to evaluate the role of Scheimpflug tomography imaging patterns in the detection of sublinical corneal edema and prediction of post-operative edema in patients with FECD undergoing phacoemulsification. Study Design: Systematic review and meta-analysis. Methods: Databases, including MEDLINE, Embase, CINAHL and Cochrane Library, were searched to identify relevant studies on patients with FECD who underwent uncomplicated phacoemulsification, with available pre-operative Scheimpflug tomography imaging data. The primary outcomes were post-operative corneal edema and the need for endothelial keratoplasty. Results: Four studies were included, comprising 263 eyes of 201 patients with FECD who underwent uncomplicated phacoemulsification. Mean age was approximately 72 years, and 71% were female. Overall, approximately 34% of patients with FECD progressed and required endothelial keratoplasty following phacoemulsification. The following characteristics based on Scheimpflug imaging were consistently indicative of pre-operative subclinical edema and predictive of post-operative progression: loss of regular isopachs, displacement of the thinnest corneal point, and focal posterior surface depression. The presence of more features simultaneously increased the probability of needing endothelial keratoplasty, ranging from 1% with no features present to 75% in the presence of all 3 features over 2 to 4 years. On the other hand, a single central corneal thickness measurement was found to be less useful in predicting corneal edema compared to the aforementioned combination of tomographic patterns. Conclusions: Pre-operative Scheimpflug tomographic patterns may help predict post-operative corneal edema and the need for endothelial keratoplasty in patients with FECD undergoing phacoemulsification. This may guide counselling and decision-making regarding combined cataract surgery and endothelial keratoplasty in high-risk patients.