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. 2022 May 19;12(1):8500.
doi: 10.1038/s41598-022-12434-8.

Cataract surgery in patients with Fuchs' dystrophy and corneal decompensation indicated for Descemet's membrane endothelial keratoplasty

Wei-Yi Chou  1   2 , Yih-Shiuan Kuo  1 , Pei-Yu Lin  3   4
Affiliations

Cataract surgery in patients with Fuchs' dystrophy and corneal decompensation indicated for Descemet's membrane endothelial keratoplasty

Wei-Yi Chou et al. Sci Rep. .

Abstract

The availability of corneal donor tissue is limited in most developing countries. This study evaluated whether patients with coexisting cataract and Fuchs' dystrophy with corneal decompensation awaiting Descemet's membrane endothelial keratoplasty (DMEK) benefited from phacoemulsification. This is a retrospective case-control study which included patients with Fuchs' dystrophy and evidence of corneal decompensation awaiting DMEK. Best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were documented at baseline (pre-cataract surgery in the case group, or at the time of transplantation registry in the control group), 1-month and pre-DMEK. A total of 16 phakic patients with visually significant cataracts had cataract surgery during the study period, and 15 pseudophakic patients were included as controls. There was no significant difference with regard to BCVA at baseline, 1-month or pre-DMEK between the case and control groups. Similarly, no significant difference in CCT was found at baseline, 1-month or pre-DMEK. In the case group, 4 patients with improved visual acuity post-cataract surgery chose to defer DMEK. After stratification, statistical analysis showed significantly better BCVA in the deferred group (n = 4) at 1-month post-cataract surgery, compared to the DMEK group (n = 12) (0.21 ± 0.21 vs. 0.86 ± 0.29 LogMAR, P = 0.004). The other parameters, including baseline BCVA and CCT at any time point documented, were not statistically different. In conclusion, in patients with Fuchs' dystrophy and decompensated corneas awaiting transplantation, phacoemulsification did not lead to significant increase of corneal thickness nor deterioration of visual acuity. A few patients achieved satisfactory vision after cataract surgery and deferred endothelial keratoplasty.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
(a) External eye photography and (c) anterior-segment OCT in a patient with Fuchs’ dystrophy and corneal edema before phacoemulsification surgery. (b, d) The same patient after surgery. (e) Specular microscopy showed indecipherable endothelial cell density before surgery.
Figure 2
Figure 2
Area under receiver operating characteristics curve (AUROC) of prediction for progression to DMEK (AUROC = 0.841).
See this image and copyright information in PMC

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