A Risk Prediction Model for Endothelial Keratoplasty After Uncomplicated Cataract Surgery in Fuchs Endothelial Corneal Dystrophy

Arnalich‐Montiel, Francisco; de-Arriba-Palomero, P.; Muriel, Alfonso; Mingo-Botín, David

doi:10.1016/j.ajo.2021.04.016

Cited by 9 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This new classification has already been applied in studies to predict the risk of FECD progression and intervention and for the prediction of edema resolution after surgery. 13,14,21,22 When grouping eyes based on the absence/presence of subclinical edema, preoperatively, there was no significant difference between the 2 groups for corneal backscatter. This implies that corneal backscatter is not a suitable indicator for detecting subclinical edema.…”

Section: Discussionmentioning

confidence: 98%

Impact of Fuchs Endothelial Corneal Dystrophy Severity on Scheimpflug-Derived Parameters After Descemet Membrane Endothelial Keratoplasty

Santana

Vasiliauskaitė

Dijk

et al. 2022

Cornea

View full text Add to dashboard Cite

The aim of this study was to evaluate how Scheimpflugderived parameters of eyes with Fuchs endothelial corneal dystrophy (FECD) are influenced by Descemet membrane endothelial keratoplasty (DMEK) depending on FECD severity and the presence of subclinical edema. Methods:A retrospective cohort study including 115 eyes (115 patients) that underwent DMEK for FECD and a control group of 27 eyes with nonpathological corneas was conducted. Preoperative and 6 months postoperative Scheimpflug imaging was used to analyze pachymetry, presence of tomographic features (loss of isopachs/ displacement of the thinnest point/focal posterior depression), and corneal backscatter. FECD severity was based on the modified Krachmer scale and the absence/presence of subclinical edema.Results: Scheimpflug-derived pachymetry, tomographic, and corneal backscatter parameters were correlated with FECD severity, and all changed from preoperatively to postoperatively (all P , 0.05). Postoperative central corneal thickness, anterior and posterior corneal backscatter, and presence of focal posterior depression remained different from the control group (all P , 0.05). Of eyes without preoperative clinical edema (n = 75), 18.7% showed 0 or 1 tomographic feature (no edema group) and 82.4% had 2 or 3 features (subclinical edema group). Compared with the control group, postoperative bestcorrected visual acuity for the "no edema" group did not differ (0.03 6 0.12 vs. 20.02 6 0.08 logarithm of the minimum angle of resolution, P = 0.150) but was worse for the subclinical edema group (0.06 6 0.08 vs. 20.02 6 0.08 logarithm of the minimum angle of resolution, P = 0.001). Conclusions:For eyes without preoperative edema, more parameters reversed back to 'normal' levels than for eyes with (sub)clinical edema. Although most analyzed parameters correlated with FECD severity, corneal tomography might be best suited for objective grading of disease severity to aid in surgical decision-making.

show abstract

Section: Discussionmentioning

confidence: 98%

Impact of Fuchs Endothelial Corneal Dystrophy Severity on Scheimpflug-Derived Parameters After Descemet Membrane Endothelial Keratoplasty

Santana

Vasiliauskaitė

Dijk

et al. 2022

Cornea

View full text Add to dashboard Cite

show abstract

“…In the future, preoperative risk assessment of the need for endothelial keratoplasty after cataract surgery can be added to the preoperative evaluation. Arnalich-Montiel et al described a model to assess the risk of endothelial keratoplasty after uneventful cataract surgery based on Scheimpflug tomography features such as a loss of parallel isopachs, displacement of the thinnest point and depression of the posterior surface combined with pachymetry measures [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy

Blau-Most

Levy²,

Assia

et al. 2023

Ophthalmol Ther

View full text Add to dashboard Cite

Introduction: Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. Methods: A retrospective case-control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism. Results:The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was -0.29 ± 0.43 vs. -0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85 D@93°± 2.42°vs. 0.23 D@68°± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1 D vs. 2.28 ± 1.03 D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24 D@28°± 0.57°vs. 0.03 D@127°± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31 D vs. 0.42 ± 0.31 D, respectively (P = 0.44). Conclusion:The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52 D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.

show abstract

“…Thus, the use of tomography can help predict which eyes may not benefit from cataract surgery alone or have a higher risk of needing EK in the future. More recently, Arnalich-Montiel et al used a combination of CCT values and the three tomographic features described above to estimate the risk of needing EK after uncomplicated phacoemulsification in patients with FECD [26]. Their model generated a score out of 8, and the cumulative risk for EK within 2 years of an uncomplicated phacoemulsification ranged from minimal risk ranging from 0.8 to 7.5% for scores \ 4 to 96.5% for those with a score of 8.…”

Section: Distinguishing the Cause Of Vision Lossmentioning

confidence: 99%

Fuchs Dystrophy and Cataract: Diagnosis, Evaluation and Treatment

2023

View full text Add to dashboard Cite

Corneal endothelium plays an important role in maintaining hydration homeostasis and clarity of the cornea. Fuchs endothelial corneal dystrophy (FECD) affects the corneal endothelium resulting in edema and characteristic excrescences on the Descemet's membrane known as corneal guttae. Descemet membrane endothelial keratoplasty (DMEK) has evolved to become the standard of care for patients with FECD with excellent visual acuity outcomes. Patients with FECD may have coexisting cataracts and therefore may require a cataract surgery, which increases the risk of corneal decompensation. The presence of FECD may not only influence the choice of intraocular lens but vision outcomes can also be affected by the corneal condition. The ability to combine the surgeries further raises important considerations regarding the timing and sequence of DMEK and cataract extraction for patients with FECD. This review provides a guide for corneal surgeons in choosing between endothelial keratoplasty and cataract surgery-alone, in combination or sequential-in their management of patients with FECD.

show abstract

A Risk Prediction Model for Endothelial Keratoplasty After Uncomplicated Cataract Surgery in Fuchs Endothelial Corneal Dystrophy

Cited by 9 publications

References 11 publications

Impact of Fuchs Endothelial Corneal Dystrophy Severity on Scheimpflug-Derived Parameters After Descemet Membrane Endothelial Keratoplasty

Impact of Fuchs Endothelial Corneal Dystrophy Severity on Scheimpflug-Derived Parameters After Descemet Membrane Endothelial Keratoplasty

Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy

Fuchs Dystrophy and Cataract: Diagnosis, Evaluation and Treatment

Contact Info

Product

Resources

About