Ophthalmology science · 2026
Sex-Specific Differences in Corneal Remodeling after Descemet Membrane Endothelial Keratoplasty in Fuchs Endothelial Corneal Dystrophy.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Kalantari Niloofar, Lang Gregor, Roters Sigrid, Jager Martine J, Seitz Berthold, Geerling Gerd, Zwingelberg Sarah Barbara
Аннотация
OBJECTIVE/PURPOSE: To evaluate sex-specific differences in preoperative disease severity and postoperative outcomes, including endothelial cell count (ECC), central corneal thickness (CCT), peripheral corneal thickness (PCT), and visual acuity, in patients with Fuchs endothelial corneal dystrophy (FECD) undergoing Descemet membrane endothelial keratoplasty (DMEK).
DESIGN: Retrospective, single-center cohort study.
PARTICIPANTS/SUBJECTS: Of the 181 eyes screened, 144 eyes (95 women, 49 men) with FECD undergoing DMEK at a tertiary referral center met the inclusion criteria of complete clinical data and ≥12 months of postoperative follow-up.
MAIN OUTCOME MEASURES: Best spectacle-corrected visual acuity (BSCVA, logarithm of the minimum angle of resolution), ECC, CCT, and PCT assessed preoperatively and at 1, 3, 6, and 12 months postoperatively.
RESULTS: Mean (standard deviation) age at surgery was 72.8 (9.6) years in women and 70.9 (10.1) years in men (P = 0.25). Preoperatively, men had lower ECC (1466 ± 362 vs. 1729 ± 370 cells/mm²; P = 0.003), greater CCT (747.0 ± 148.0 vs 678.3 ± 128.8 µm; P = 0.014), and greater PCT (782.4 ± 105.1 vs. 702.6 ± 65.1 µm; P < 0.001), while BSCVA was comparable (P = 0.26). Following DMEK, both sexes showed similar visual improvement and CCT normalization. At 12 months, BSCVA (P = 0.26) and CCT (P = 0.98) did not differ significantly, whereas men had lower ECC (1487 ± 330 vs. 1727 ± 415 cells/mm²; P = 0.004) and greater PCT (722.6 ± 71.7 vs. 681.5 ± 66.3 µm; P = 0.015). In multivariable analysis, male sex was independently associated with greater 12-month PCT (P < 0.001), but not with 12-month ECC after adjustment for baseline disease severity and donor-related factors.
CONCLUSIONS: Men with FECD exhibited more pronounced preoperative structural corneal changes and greater PCT after DMEK despite comparable visual recovery. Biological sex remained independently associated with postoperative PCT, but not ECC, after adjustment. These findings suggest sex-specific differences in FECD structural manifestations and postoperative corneal remodeling and warrant validation in prospective multicenter studies.
DESIGN: Retrospective, single-center cohort study.
PARTICIPANTS/SUBJECTS: Of the 181 eyes screened, 144 eyes (95 women, 49 men) with FECD undergoing DMEK at a tertiary referral center met the inclusion criteria of complete clinical data and ≥12 months of postoperative follow-up.
MAIN OUTCOME MEASURES: Best spectacle-corrected visual acuity (BSCVA, logarithm of the minimum angle of resolution), ECC, CCT, and PCT assessed preoperatively and at 1, 3, 6, and 12 months postoperatively.
RESULTS: Mean (standard deviation) age at surgery was 72.8 (9.6) years in women and 70.9 (10.1) years in men (P = 0.25). Preoperatively, men had lower ECC (1466 ± 362 vs. 1729 ± 370 cells/mm²; P = 0.003), greater CCT (747.0 ± 148.0 vs 678.3 ± 128.8 µm; P = 0.014), and greater PCT (782.4 ± 105.1 vs. 702.6 ± 65.1 µm; P < 0.001), while BSCVA was comparable (P = 0.26). Following DMEK, both sexes showed similar visual improvement and CCT normalization. At 12 months, BSCVA (P = 0.26) and CCT (P = 0.98) did not differ significantly, whereas men had lower ECC (1487 ± 330 vs. 1727 ± 415 cells/mm²; P = 0.004) and greater PCT (722.6 ± 71.7 vs. 681.5 ± 66.3 µm; P = 0.015). In multivariable analysis, male sex was independently associated with greater 12-month PCT (P < 0.001), but not with 12-month ECC after adjustment for baseline disease severity and donor-related factors.
CONCLUSIONS: Men with FECD exhibited more pronounced preoperative structural corneal changes and greater PCT after DMEK despite comparable visual recovery. Biological sex remained independently associated with postoperative PCT, but not ECC, after adjustment. These findings suggest sex-specific differences in FECD structural manifestations and postoperative corneal remodeling and warrant validation in prospective multicenter studies.