Delphi-Based Global Consensus on Fuchs Endothelial Corneal Dystrophy. An Endothelial Keratoplasty Learners Group Initiative

Sanjay V Patel¹, Nidhi Gupta², Maninder Bhogal³, Ula V Jurkunas⁴, Naoki Okumura⁵, Vito Romano⁶, Bruce D Allan⁷, Keith H Baratz⁸, Samar K Basak⁹, Lamis Baydoun¹⁰, Winston Chamberlain¹¹, Sunita Chaurasia¹², Kathryn Colby¹³, Claus Cursiefen¹⁴, Ticiano Giobellina¹⁵, Mark A Greiner¹⁶, Jesper Hjortdal¹⁷, Akira Kobayashi¹⁸, Viridiana Kocaba¹⁹, Ellen H Koo²⁰, W Barry Lee²¹, Eitan Livny²², John J Males²³, Mario Matthaei¹⁴, Jodhbir S Mehta²⁴, Luis Mejia²⁵, Gregory Moloney²⁶, V Vinod Mootha²⁷, Marc Muraine²⁸, Yoshinori Oie²⁹, Nicolas Cesário Pereira³⁰, Francis W Price Jr³¹, Divya Srikumaran³², Mark A Terry³³, Peter B Veldman³⁴, David D Verdier³⁵, Pravin K Vaddavalli¹², Roberto Pineda 2nd⁴

Affiliations

¹ From the Department of Ophthalmology (S.V.P., K.H.B.), Mayo Clinic, Rochester, MN, USA. Electronic address: patel.sanjay@mayo.edu.
² Cornea Department, Dr. Shroffs Charity Eye Hospital (N.G.), New Delhi, India; Singapore Eye Research Institute (N.G., V.K., J.S.M.), Singapore.
³ Department of Ophthalmology, St. Thomas' Hospital (M.B.), London, UK.
⁴ Department of Ophthalmology, Massachusetts Eye and Ear (U.V.J., R.P.), Harvard Medical School, Boston, MA, USA.
⁵ Department of Biomedical Engineering, Faculty of Life and Medical Sciences (N.O.), Doshisha University, Kyoto, Japan.
⁶ Department of Medical and Surgical Specialties, Eye Unit, Radiological Sciences, and Public Health (V.R.), University of Brescia, Brescia, Italy.
⁷ Cornea Service, Moorfields Eye Hospital (B.D.A.), London, UK.
⁸ From the Department of Ophthalmology (S.V.P., K.H.B.), Mayo Clinic, Rochester, MN, USA.
⁹ Cornea & External Diseases, Disha Eye Hospitals (S.K.B.), Kolkata, India.
¹⁰ ELZA Institute Dietikon/Zurich (L.B.), Switzerland.
¹¹ The Casey Eye Institute (W.C.), Oregon Health & Science University, Portland, OR, USA.
¹² LV Prasad Eye Institute (S.C., P.K.V.), Hyderabad, India.
¹³ Department of Ophthalmology, NYU Grossman School of Medicine (K.C.), New York, NY, USA.
¹⁴ Department of Ophthalmology (C.C., M.M.), University of Cologne, Cologne, Germany.
¹⁵ Reyes-Giobellina Eye Clinic (T.G.), Córdoba, Argentina.
¹⁶ Department of Ophthalmology and Visual Sciences (M.A.G.), University of Iowa Carver College of Medicine, Iowa City, IA, USA.
¹⁷ Department of Ophthalmology, Aarhus University Hospital (J.H.), Aarhus, Denmark.
¹⁸ Department of Ophthalmology (A.K.), Kanazawa University Hospital, Kanazawa, Japan.
¹⁹ Singapore Eye Research Institute (N.G., V.K., J.S.M.), Singapore; Clinique de la Part-Dieu & Bellecour Vision Clinic (V.K.), Lyon, France.
²⁰ Department of Ophthalmology (E.H.K.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
²¹ Eye Consultants of Atlanta (W.B.L.), Atlanta, GA, USA.
²² Rabin Medical Center (E.L.), Petach Tikva, Israel; Department of Ophthalmology, Tel Aviv University (E.L.), Tel Aviv, Israel.
²³ Save Sight Institute, University of Sydney (J.J.M., G.M.), Sydney, Australia.
²⁴ Singapore Eye Research Institute (N.G., V.K., J.S.M.), Singapore; Singapore National Eye Centre (J.S.M.), Singapore.
²⁵ Clínica COM (L.M.), Medellín, Colombia.
²⁶ Save Sight Institute, University of Sydney (J.J.M., G.M.), Sydney, Australia; Department of Ophthalmology, University of British Columbia (G.M.), Vancouver, Canada.
²⁷ Department of Ophthalmology, University of Texas Southwestern Medical Center (V.V.M.), Dallas, TX, USA.
²⁸ Charles Nicolle Hospital (M.M.), Rouen University Hospital, Rouen, France.
²⁹ Department of Ophthalmology (Y.O.), University of Osaka Graduate School of Medicine.
³⁰ Sorocaba Eye Hospital (N.C.P.), Soracaba, Brazil.
³¹ Price Vision Group (F.W.P.), Indianapolis, IN, USA.
³² Wilmer Eye Institute, Johns Hopkins University (D.S.), Baltimore, MD, USA.
³³ Legacy Devers Eye Institute (M.A.T.), Portland, OR, USA.
³⁴ Department of Ophthalmology and Visual Science (P.B.V.), University of Chicago, Chicago, IL, USA.
³⁵ Grand Rapids (D.D.V.), Verdier Eye Center, MI, USA.

PMID: 40789362
DOI: 10.1016/j.ajo.2025.08.012

Delphi-Based Global Consensus on Fuchs Endothelial Corneal Dystrophy. An Endothelial Keratoplasty Learners Group Initiative

Sanjay V Patel et al. Am J Ophthalmol. 2025.

. 2025 Aug 9:280:130-143.

doi: 10.1016/j.ajo.2025.08.012. Online ahead of print.

Authors

Affiliations

¹ From the Department of Ophthalmology (S.V.P., K.H.B.), Mayo Clinic, Rochester, MN, USA. Electronic address: patel.sanjay@mayo.edu.
² Cornea Department, Dr. Shroffs Charity Eye Hospital (N.G.), New Delhi, India; Singapore Eye Research Institute (N.G., V.K., J.S.M.), Singapore.
³ Department of Ophthalmology, St. Thomas' Hospital (M.B.), London, UK.
⁴ Department of Ophthalmology, Massachusetts Eye and Ear (U.V.J., R.P.), Harvard Medical School, Boston, MA, USA.
⁵ Department of Biomedical Engineering, Faculty of Life and Medical Sciences (N.O.), Doshisha University, Kyoto, Japan.
⁶ Department of Medical and Surgical Specialties, Eye Unit, Radiological Sciences, and Public Health (V.R.), University of Brescia, Brescia, Italy.
⁷ Cornea Service, Moorfields Eye Hospital (B.D.A.), London, UK.
⁸ From the Department of Ophthalmology (S.V.P., K.H.B.), Mayo Clinic, Rochester, MN, USA.
⁹ Cornea & External Diseases, Disha Eye Hospitals (S.K.B.), Kolkata, India.
¹⁰ ELZA Institute Dietikon/Zurich (L.B.), Switzerland.
¹¹ The Casey Eye Institute (W.C.), Oregon Health & Science University, Portland, OR, USA.
¹² LV Prasad Eye Institute (S.C., P.K.V.), Hyderabad, India.
¹³ Department of Ophthalmology, NYU Grossman School of Medicine (K.C.), New York, NY, USA.
¹⁴ Department of Ophthalmology (C.C., M.M.), University of Cologne, Cologne, Germany.
¹⁵ Reyes-Giobellina Eye Clinic (T.G.), Córdoba, Argentina.
¹⁶ Department of Ophthalmology and Visual Sciences (M.A.G.), University of Iowa Carver College of Medicine, Iowa City, IA, USA.
¹⁷ Department of Ophthalmology, Aarhus University Hospital (J.H.), Aarhus, Denmark.
¹⁸ Department of Ophthalmology (A.K.), Kanazawa University Hospital, Kanazawa, Japan.
¹⁹ Singapore Eye Research Institute (N.G., V.K., J.S.M.), Singapore; Clinique de la Part-Dieu & Bellecour Vision Clinic (V.K.), Lyon, France.
²⁰ Department of Ophthalmology (E.H.K.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
²¹ Eye Consultants of Atlanta (W.B.L.), Atlanta, GA, USA.
²² Rabin Medical Center (E.L.), Petach Tikva, Israel; Department of Ophthalmology, Tel Aviv University (E.L.), Tel Aviv, Israel.
²³ Save Sight Institute, University of Sydney (J.J.M., G.M.), Sydney, Australia.
²⁴ Singapore Eye Research Institute (N.G., V.K., J.S.M.), Singapore; Singapore National Eye Centre (J.S.M.), Singapore.
²⁵ Clínica COM (L.M.), Medellín, Colombia.
²⁶ Save Sight Institute, University of Sydney (J.J.M., G.M.), Sydney, Australia; Department of Ophthalmology, University of British Columbia (G.M.), Vancouver, Canada.
²⁷ Department of Ophthalmology, University of Texas Southwestern Medical Center (V.V.M.), Dallas, TX, USA.
²⁸ Charles Nicolle Hospital (M.M.), Rouen University Hospital, Rouen, France.
²⁹ Department of Ophthalmology (Y.O.), University of Osaka Graduate School of Medicine.
³⁰ Sorocaba Eye Hospital (N.C.P.), Soracaba, Brazil.
³¹ Price Vision Group (F.W.P.), Indianapolis, IN, USA.
³² Wilmer Eye Institute, Johns Hopkins University (D.S.), Baltimore, MD, USA.
³³ Legacy Devers Eye Institute (M.A.T.), Portland, OR, USA.
³⁴ Department of Ophthalmology and Visual Science (P.B.V.), University of Chicago, Chicago, IL, USA.
³⁵ Grand Rapids (D.D.V.), Verdier Eye Center, MI, USA.

PMID: 40789362
DOI: 10.1016/j.ajo.2025.08.012

Abstract

Purpose: To identify areas of consensus among global experts for the management of Fuchs endothelial corneal dystrophy (FECD) in clinical practice, including its diagnosis, evaluation, decision-making principles with respect to intervention, and recommendations for performing cataract surgery in patients with FECD, including when to combine with keratoplasty.

Design: Modified Delphi-based global consensus.

Participants: Thirty-seven ophthalmologists from around the world with significant expertise in the management and mechanisms of FECD.

Methods: A series of consensus statements about FECD were developed from three iterative rounds of structured questions and statements posed to the panel of experts. Two rounds were asynchronous electronic questionnaires, and the third round was a live virtual meeting. Experts responded anonymously to statements assessing consensus and to open-ended questions that invited diverse input.

Main outcome measures: Consensus was defined as 70% agreement among experts.

Results: Consensus was reached for 90 of 91 statements after three rounds. Experts agreed that FECD is defined by the presence of central or paracentral scattered or confluent guttae with or without edema. There was strong consensus that a chronic state of subclinical edema precedes the onset of clinically detectable edema that may or may not cause symptoms. With near-unanimous consensus, disease evaluation recommendations included assessing for findings that implicate the cornea as a source of decreased vision to separate it from the effect of comorbid conditions, as this would inform whether corneal intervention is appropriate. These findings include diurnal variation in vision, clinical or subclinical (tomographic) edema, and changes or differences in central corneal thickness. Based on current evidence, experts agreed that there are no effective medical therapies for FECD, and that Descemet membrane endothelial keratoplasty is the surgical treatment of choice when indicated.

Conclusions: The consensus statements provide current globally endorsed recommendations for the diagnosis and management of FECD. The guidelines are important and relevant for general ophthalmologists, who typically first diagnose and evaluate FECD, and for cornea specialists, by allowing them to benchmark their current practice patterns against expert recommendations. This could help improve patient outcomes and establish a framework adaptable to future advances and evolving technologies in the management of FECD.

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Delphi-Based Global Consensus on Fuchs Endothelial Corneal Dystrophy. An Endothelial Keratoplasty Learners Group Initiative

Affiliations

Delphi-Based Global Consensus on Fuchs Endothelial Corneal Dystrophy. An Endothelial Keratoplasty Learners Group Initiative

Authors

Affiliations

Abstract

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