Predicting factors of corneal decompensation following cataract surgery in Fuchs' endothelial corneal dystrophy

Session Details

Session Title: Corneal Endothelium & Cataract Surgery

Session Date/Time: Monday 24/09/2018 | 16:30-18:00

Paper Time: 16:42

Venue: Room A3, Podium 1

First Author: : F.Arnalich SPAIN

Co Author(s): :    D. Mingo   P. De Arriba                 

Abstract Details

Purpose:

To determine preoperative corneal measurements that predicts the need for endothelial keratoplasty (EK) in patients with Fuchs' endothelial corneal dystrophy (FECD) undergoing cataract surgery.

Setting:

HOSPITAL UNIVERSITARIO RAMÓN Y CAJAL, MADRID, SPAIN

Methods:

A Prospective, observational cohort study, including Forty-five patients (60 eyes) with FECD who require cataract surgery. Patients were assessed for best-corrected visual acuity, Pentacam Scheimpflug central corneal thickness (CCT), Casia S100 Anterior Segment OCT CCT, endothelial cell count, cataract density at slit-lamp examination, and central corneal backscatter using Pentacam Scheimpflug technology. After surgery, measurements were repeated at 2 months. We used stepwise binary logistic regression analysis to evaluate 10 preoperative parameters for their ability to predict the postoperative need for EK. Receiver operating characteristic (ROC) curves of the predictive factors were used to identify their optimal cutoff points.

Results:

After surgery, 21(35%) of 60 eyes needed EK. Of all parameters, CCT and corneal backscatter were identified as significant predictive factors. The highest area under the ROC curve was posterior layer (PL) backscatter (0.928), not significantly higher than Pentacam CCT (0.899; P = 0.263). As optimal cutoff points, we chose 17.1 standardized grayscale units (GSU) for PL backscatter and 621 μm for CCT which correspond with a specificity of 92.3% and sensitivity of 78.6% and 57.1% respectively. The combination of both parameters for the optimal cutoff point correspond with a specificity of 92.3 % and a sensitivity of 92.9%.

Conclusions:

Backscatter at the posterior layer and CCT measured by Pentacam Scheimpflug Technology predicts the need for EK after cataract surgery in patients with FECD although CCT remains less effective. As an indicator for the corneal hydration state, the combination of both measures improves patient selection for combined cataract surgery and EK. Regardless of the predictive factor used, a tailor-made approach is recommended accounting for individuals' expectations.

Financial Disclosure:

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