Incidence of corneal transplantation after phacoemulsification in patients with corneal guttata: a registry-based cohort study

Viberg, Andreas; Samolov, Branka; Armitage, Margareta Claesson; Behndig, Anders; Byström, Berit

doi:10.1097/j.jcrs.0000000000000207

Cited by 11 publications

(18 citation statements)

References 29 publications

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“…A registry-based cohort study in the Swedish between 2010 to 2012 found that the overall incidence rate of corneal transplantation after phacoemulsification among patients with guttata was 9 per 1000 person years. 12 The incidence rate of CEF in our study is approximately 3 times compared to Swedish registry. Different ethnicities, patient characteristics, time frames and outcome definitions (CEF vs. corneal transplantation) could possibly explain the dissimilar results.…”

Section: Discussionmentioning

confidence: 49%

“… 11 Recently, a large cohort conducted in Sweden showed that the incidence rate of corneal transplantation after phacoemulsification was as high as 68.2 times for patients with corneal guttata compared to those without (1.4 per 10,000 person years). 12 Studies from Arnalich-Montiel et al 13 and Patel et al 14 identified preoperative corneal tomographic features from Pentacam (Oculus, Wetzlar, Germany) as predicting factors for disease progression following cataract surgery in FECD patients. However, the authors did not assess intraoperative variables that could also affect the risk.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Risk Factors of Corneal Endothelial Failure after Phacoemulsification in Patients with Fuchs Endothelial Corneal Dystrophy: A 13-Year Retrospective Cohort

Chuckpaiwong

Muakkul

Phimpho

et al. 2021

OPTH

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Objective To evaluate the incidence of corneal endothelial failure (CEF) and determine the risk factors of developing CEF after phacoemulsification in patients with Fuchs endothelial corneal dystrophy (FECD). Methods A retrospective chart review of 2873 patients who underwent phacoemulsification with intraocular lens (IOL) implantation was conducted at Ramathibodi Hospital, Bangkok, Thailand from January 2007 to December 2019. Patient baseline characteristics, underlying diseases, levels of nuclear cataract, pre-operative specular microscopic parameters, intraoperative information (cumulative dissipated energy [CDE], mode of phacoemulsification, and complications), and occurrence of CEF were collected. Data were analyzed using Kaplan–Meier (KM) method and Cox proportional hazard model. Results Ninety-four patients diagnosed with FECD at follow-up time of more than 6 months were included for analysis. Mean age was 70.3 ± 7.7 years with female predominance (81.91%). Median follow-up time was 3.2 years. Nine (9.57%) patients developed CEF during follow-up period. The overall incidence rate of CEF after phacoemulsification was 26 per 1000 person years (95% confidence interval [CI]; 14 to 49 per 1000 person years). Only intraoperative complications showed significant association with CEF at hazard ratio (HR) of 6.03 (95% CI 1.50 to 26.50). No significant association was found among age, gender, underlying diseases, level of nuclear sclerosis and pre-operative specular microscopic parameters. Conclusion Intraoperative complications should be considered as an important risk factor for developing post-operative CEF in FECD patients. Apart from assessing pre-operative parameters, surgeons should also consider the possibility of and try to avoid any intra-operative complications, which could potentially result in CEF after phacoemulsification for each individual patient.

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Section: Discussionmentioning

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors of Corneal Endothelial Failure after Phacoemulsification in Patients with Fuchs Endothelial Corneal Dystrophy: A 13-Year Retrospective Cohort

Chuckpaiwong

Muakkul

Phimpho

et al. 2021

OPTH

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“…Certainly, in the case of confluent guttata which precludes imaging of the central endothelial layer, one can generally assume that the disease is well advanced and that there is an increased risk of endothelial decompensation. In this context, the risk of needing a corneal transplant following a cataract surgery is 68 times higher in patients with cornea guttata than in patients with no cornea guttata; this is derived from an analysis of register data pertaining to over 275,000 people having undergone a cataract surgery [9]. On the other hand, the incidence of keratoplasty in patients with cornea guttata is 88 per 100,000, which means that the majority of affected individuals do not need to have a corneal transplant after their cataract surgery [9].…”

Section: Preoperative Considerationsmentioning

confidence: 99%

“…In this context, the risk of needing a corneal transplant following a cataract surgery is 68 times higher in patients with cornea guttata than in patients with no cornea guttata; this is derived from an analysis of register data pertaining to over 275,000 people having undergone a cataract surgery [9]. On the other hand, the incidence of keratoplasty in patients with cornea guttata is 88 per 100,000, which means that the majority of affected individuals do not need to have a corneal transplant after their cataract surgery [9]. In order to determine the best surgical procedure in any individual case, in 2014 Cleynenbreugel et al [10] performed a retrospective study in an attempt to determine the preoperative prognostic factors pertaining to keratoplasty following cataract surgery.…”

Section: Preoperative Considerationsmentioning

confidence: 99%

“…Allerdings kann bei konfluierenden Guttae und einer nicht darstellbaren zentralen Endothelzellschicht i. d. R. von einem fortgeschrittenen Befund mit einem erhöhten Risiko für eine Endotheldekompensation ausgegangen werden. In diesem Zusammenhang ist das Risiko für die Notwendigkeit einer Hornhauttransplantation nach einer Kataraktoperation bei Menschen mit einer Cornea guttata 68-mal höher als bei Menschen ohne eine Cornea guttata, was die Analyse der Registerdaten von mehr als 275 000 Menschen nach Kataraktoperation ergab [9]. Auf der anderen Seite lag die Häufigkeit einer Keratoplastik bei den Menschen mit Cornea guttata bei 88 pro 100 000, was bedeutet, dass ein Großteil der Betroffenen nach einer Kataraktoperation keine Transplantation benötigte [9].…”

Section: Präoperative üBerlegungenunclassified

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Kataraktoperation beim Vorliegen einer Fuchs-Endotheldystrophie

Maier

Reinhard

2022

Klin Monbl Augenheilkd

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ZusammenfassungBei Betroffenen mit einer Fuchs-Endotheldystrophie beginnen die Probleme mit den Augen häufig in einem Alter, in dem sich auch schon erste Anzeichen einer Katarakt zeigen. Und umgekehrt findet man in der augenärztlichen Praxis immer wieder Patient*innen mit einer deutlichen Katarakt und einer Cornea guttata als Nebenbefund. In beiden Situationen stellt sich dann die Frage, ob zunächst nur eine posteriore lamelläre Keratoplastik (in Deutschland meist als DMEK) bzw. nur eine Kataraktoperation erfolgen oder ob gleich ein kombiniertes Vorgehen (sog. Triple-Operation) angestrebt werden sollte. Nur bei jungen Betroffenen mit einer fortgeschrittenen Fuchs-Endotheldystrophie ohne jeglichen Hinweis auf eine Katarakt und gut erhaltener Akkommodation kann, je nach individuellen Gegebenheiten, eine alleinige DMEK sinnvoll sein, in allen anderen Fällen erscheint eine Triple-Operation geeigneter. Dabei erscheint ein sequenzielles Vorgehen in diesen Situationen weniger angebracht, da sich in zahlreichen Studien zeigte, dass der Verlauf und die Ergebnisse nach einer Triple-Operation mit denen nach einem sequenziellen Vorgehen vergleichbar sind. Beim Vorliegen einer signifikanten Katarakt und einer Cornea guttata fällt die Entscheidung im Hinblick auf das operative Vorgehen deutlich schwerer. Hierbei gibt es unterschiedliche Aspekte in der Anamnese sowie den ophthalmologischen Untersuchungen (z. B. zentrale Hornhautdicke, Endothelzelldichte), die einem bei der Entscheidung helfen können. Soll dann zunächst nur eine Kataraktoperation erfolgen, sollten geeignete Maßnahmen ergriffen werden, um ein möglichst optimales Ergebnis trotz Vorliegen der Cornea guttata zu erreichen. Im folgenden Beitrag soll auf die wichtigsten prä-, peri- und postoperativen Aspekte im Hinblick auf die bestmögliche operative Versorgung von Betroffenen mit Fuchs-Endotheldystrophie und Katarakt eingegangen werden.

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

Blau-Most

Levy²,

Assia

et al. 2023

Ophthalmol Ther

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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.

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Incidence of corneal transplantation after phacoemulsification in patients with corneal guttata: a registry-based cohort study

Cited by 11 publications

References 29 publications

Incidence and Risk Factors of Corneal Endothelial Failure after Phacoemulsification in Patients with Fuchs Endothelial Corneal Dystrophy: A 13-Year Retrospective Cohort

Incidence and Risk Factors of Corneal Endothelial Failure after Phacoemulsification in Patients with Fuchs Endothelial Corneal Dystrophy: A 13-Year Retrospective Cohort

Kataraktoperation beim Vorliegen einer Fuchs-Endotheldystrophie

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

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