Risk factors for postoperative endothelial keratoplasty after cataract surgery in patients with Fuchs endothelial corneal dystrophy using anterior segment optical coherence tomography.

PURPOSE: To analyze anterior segment optical coherence tomography (AS-OCT)-derived risk factors for endothelial keratoplasty (EK) after cataract surgery in patients with Fuchs endothelial corneal dystrophy (FECD).

STUDY

DESIGN

Retrospective observational study.

METHODS

We included 73 eyes from 55 consecutive patients with FECD who underwent cataract surgery at three tertiary care institutions between March 2017 and July 2023. We explored the association between preoperative factors (age, sex, incision site, central corneal thickness, anterior chamber depth, components for the anterior and posterior corneal surfaces by Fourier analysis, and signal intensity by AS-OCT) and the requirement for EK within 12 months after cataract surgery. We performed univariate and multivariate regression analyses to calculate the area under the receiver operating characteristic curve (AUC).

RESULTS

Of the 73 eyes, 27 (37.0%) required EK. In the univariate analysis, the higher order irregularity component of the 6 mm posterior corneal surface by Fourier analysis yielded the highest AUC of 0.86 (sensitivity: 0.85; specificity: 0.74). In the multivariate analysis, the asymmetry component of the 3 mm anterior corneal surface by Fourier analysis yielded the highest AUC of 0.94, in addition to age, sex, incision site, and anterior chamber depth (sensitivity: 0.93; specificity: 0.85). Thus, we developed a novel logistic regression model incorporating fully quantitative imaging biomarkers from AS-OCT to estimate the probability of requiring EK.

CONCLUSION

The multiple regression model might provide a practical framework for optimizing surgical planning in patients with FECD undergoing cataract surgery, including deciding for either cataract surgery alone or combined EK.