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Viberg A, Bro T, Behndig A, Kugelberg M, Zetterberg M, Nilsson I, Lundström M. Ten-year trends of delayed sequential bilateral cataract surgery (DSBCS) in Sweden: a register-based study. EYE AND VISION (LONDON, ENGLAND) 2024; 11:39. [PMID: 39350282 PMCID: PMC11443835 DOI: 10.1186/s40662-024-00406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 09/04/2024] [Indexed: 10/04/2024]
Abstract
PURPOSE To study the trend of delayed sequential bilateral cataract surgery (DSBCS) in Sweden in the past decade. METHODS This register-based cohort study utilized data from the Swedish National Cataract Register (NCR) from 2010 through 2019. Register files from patients who underwent cataract surgery in both eyes during the study period were linked using their social security numbers. Bilateral surgeries on different days were classified as DSBCS. The study investigated the association between DSBCS within 3 months and several variables with stratification and multivariate logistic regression. The following variables were used: operation year, region, private or public unit, age, sex, indication for surgery, type of intraocular lens (IOL), preoperative visual acuity, ocular comorbidity, posterior capsule rupture and perioperative difficulties. RESULTS During the study period, 368,106 patients underwent DSBCS, of which 62.6% (n = 230,331) had bilateral surgery within 3 months. The median time between the surgeries was 61 days (interquartile range 26-161 days), showing regional variations. Better visual acuity in the fellow eye, presence of ocular comorbidity, various perioperative events and complications were associated with longer time to surgery of the second eye. Conversely, cataract surgery in more recent years, private clinic, increasing age, anisometropia and multifocal IOL were associated with shorter timespan between surgeries. CONCLUSIONS The majority of DSBCS were conducted within a 3-month timeframe, with the interval between surgeries decreasing throughout the study period. Several rational factors were associated with the time difference, in addition to regional variations. Many patients would probably benefit from less time between the surgeries, and we encourage a clinical practice taking the whole patient's visual function into account.
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Affiliation(s)
- Andreas Viberg
- Department of Clinical Sciences, Ophthalmology, Umeå University, 901 85, Umeå, Sweden.
| | - Tomas Bro
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Behndig
- Department of Clinical Sciences, Ophthalmology, Umeå University, 901 85, Umeå, Sweden
| | - Maria Kugelberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | | | - Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
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Lundström M, Kugelberg M, Zetterberg M, Nilsson I, Viberg A, Bro T, Behndig A. Ten-year trends of immediate sequential bilateral cataract surgery (ISBCS) as reflected in the Swedish National Cataract Register. Acta Ophthalmol 2024; 102:68-73. [PMID: 37133405 DOI: 10.1111/aos.15688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/14/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE To analyse trends of ISBCS reported to the Swedish National Cataract Register (NCR) over a 10-year period. METHODS Since 2010 the NCR contains social security number of all individuals in the list of parameters reported to NCR after each cataract procedure. Bilateral surgeries were mapped out using social security numbers. When dates of both-eye surgeries are identical for an individual it is classified as an immediate sequential bilateral cataract surgery (ISBCS). This study includes all data reported during the period 1st of January 2010 to 31st of December 2019. During the study period 113 cataract surgery clinics affiliated to the NCR reported their data on consecutive cataract cases. RESULTS For the whole period 54 194 ISBCS were reported. The total number of bilateral cataract extractions was 422 300. There was a significant trend of increasing ISBCS over time with linear regression (Beta = 1.75, p < 0.001). In ISBCS the occurrence of an ocular comorbidity decreased over time. The use of a capsular tension ring was significantly more common in ISBCS than in delayed sequential bilateral cataract surgery (DSBCS). All other measures taken during surgery were more common in DSBCS. The use of multifocal IOL was significantly more frequent in ISBCS compared to DSBCS (p < 0.001). CONCLUSIONS The use of ISBCS has increased over the study period. The operated eyes have less risk factors than eyes going through a DSBCS, but both ocular comorbidities and surgical complications occur in ISBCS eyes.
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Affiliation(s)
- Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria Kugelberg
- SöderÖgon, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andreas Viberg
- Department of Clinical Sciences, Ophthalmology, Umea University, Umeå, Sweden
| | - Tomas Bro
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Behndig
- Department of Clinical Sciences, Ophthalmology, Umea University, Umeå, Sweden
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Blau-Most M, Levy A, Assia EI, Kleinmann G. Clinical Outcomes of Toric Intraocular Lenses in Patients with Fuchs Endothelial Corneal Dystrophy. Ophthalmol Ther 2023; 12:1747-1755. [PMID: 37052875 PMCID: PMC10164209 DOI: 10.1007/s40123-023-00700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/03/2023] [Indexed: 04/14/2023] Open
Abstract
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) (D diopters). 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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Affiliation(s)
- Michal Blau-Most
- Ein-Tal Eye Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Levy
- Ein-Tal Eye Center, Tel Aviv, Israel
| | - Ehud I Assia
- Ein-Tal Eye Center, Tel Aviv, Israel
- Department of Ophthalmology, Meir Medical Center, Kfar Sava, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Kleinmann
- Ein-Tal Eye Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Ophthalmology, E. Wolfson Medical Center, 62 Halohamim St., POB 5, 5810001, Holon, Israel.
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Clinical outcomes of presbyopia-correcting intraocular lenses in patients with Fuchs endothelial corneal dystrophy. Sci Rep 2023; 13:786. [PMID: 36646806 PMCID: PMC9842705 DOI: 10.1038/s41598-023-27830-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Fuchs endothelial corneal dystrophy (FECD) is considered a contraindication for the implantation of presbyopia-correcting IOLs, without sufficient corroborating evidence. A Retrospective, case-control study. Nineteen eyes of ten patients with grade 2-5 FECD (study group) and 57 healthy eyes of 57 patients (control group) who underwent cataract surgery with implantation of presbyopia-correcting IOLs, at the Ein-Tal Eye Center, Tel Aviv, Israel, were included. The target refraction was emmetropia for both groups. Two subgroups of IOLs were analyzed separately: extended depth of focus (EDOF), (9 eyes of FECD patients and 27 eyes of control patients) and multifocal IOLs (10 eyes of FECD patients and 30 eyes of control patients). Main outcome measures were visual acuity and refraction 6 weeks after the surgery. Secondary outcomes were patient perceptions of visual acuity, spectacle independence, photic phenomena and satisfaction scores, reported in a self-assessment questionnaire. FECD patients in the EDOF IOL subgroup had inferior uncorrected distance visual acuity (P = 0.007) and better uncorrected near visual acuity (P = 0.001) compared to the controls. They had less spectacle independence for the intermediate range (P = 0.01) and overall (P = 0.006). However, they did not have more photic phenomena. In the multifocal IOL subgroup, no significant differences were found between the FECD and the control group in visual acuity for all ranges and in spectacle independence. FECD patients had more photic phenomena than the controls (P = 0.006), but it did not interfere with daily life activities. There was no difference in post-operative mean spherical equivalent, patient reported visual perception, and general satisfaction between FECD and control patients in both groups. Our results suggest that presbyopia-correcting IOLs can be carefully considered in patients with grade 2-5 FECD, with slightly inferior results compared with healthy eyes.
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Chu HS, Hu FR, Liu HY, Srikumaran D. Keratoplasty Registries: Lessons Learned. Cornea 2023; 42:1-11. [PMID: 36459579 DOI: 10.1097/ico.0000000000003088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
ABSTRACT Clinical registries have been developed for decades in the field of ophthalmology, and they are especially well-suited to the study of keratoplasty practices. A comprehensive donor/recipient registry system can provide insight into donor, recipient, and surgical factors associated with immediate and long-term outcomes and adverse reactions. Furthermore, linkage with demographic databases can elucidate relationships with social determinants of health and potentially shape public policy. The vast sample size and multicenter nature of registries enable researchers to conduct sophisticated multivariate or multilayered analyses. In this review, we aim to emphasize the importance of registry data for keratoplasty practice and 1) summarize the structure of current keratoplasty registries; 2) examine the features and scientific contributions of the registries from Australia, the United Kingdom, Singapore, the Netherlands, Sweden, Eye Bank Association of America, and European Cornea and Cell Transplant registries; 3) compare registry-based studies with large single-site clinical studies; 4) compare registry-based studies with randomized control studies; and 5) make recommendations for future development of keratoplasty registries. Keratoplasty registries have increased our knowledge of corneal transplant practices and their outcomes. Future keratoplasty registry-based studies may be further strengthened by record linkage, data sharing, and international collaboration.
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Affiliation(s)
- Hsiao-Sang Chu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Eye Bank of Taiwan, Ministry of Health and Welfare, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; and
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Eye Bank of Taiwan, Ministry of Health and Welfare, Taipei, Taiwan
| | - Hsin-Yu Liu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- National Eye Bank of Taiwan, Ministry of Health and Welfare, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; and
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Maier PC, Reinhard T. Kataraktoperation beim Vorliegen einer Fuchs-Endotheldystrophie. Klin Monbl Augenheilkd 2022; 239:767-774. [DOI: 10.1055/a-1756-5199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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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Affiliation(s)
- Philip Christian Maier
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Thomas Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Moshirfar M, Huynh R, Ellis JH. Cataract surgery and intraocular lens placement in patients with Fuchs corneal dystrophy: a review of the current literature. Curr Opin Ophthalmol 2022; 33:21-27. [PMID: 34743088 DOI: 10.1097/icu.0000000000000816] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Late-onset Fuchs endothelial corneal dystrophy (FECD) is seen in approximately 4% of individuals over the age of 40. With the growing population of adults over the age of 65, ophthalmologists need to be aware of the preoperative, perioperative, and postoperative considerations involved in cataract surgery in Fuchs patients. RECENT FINDINGS Management of cataract patients with FECD requires preoperative assessment of endothelial cell size, density, and morphology. Considerations for perioperative endothelial cell loss include patients with hyperopia and shallow anterior chambers, phacoemulsification technique, transfer of ultrasonic energy to the cornea, corneal-protective perioperative agents, as well as thermal and mechanical damage. SUMMARY Ophthalmologists performing cataract surgery on patients with FECD must carefully consider the risks of endothelial cell loss during surgery and minimize the risk of corneal decompensation after surgery. Preoperative management should evaluate the severity of the FECD as well as individual factors such as cataract density, the health and thickness of the cornea, and the anterior chamber depth. Perioperative techniques, adjustments to biometry calculations, and intraocular lens (IOL) selection may help optimize visual outcomes and recovery time.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, Utah, USA
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA
- Utah Lions Eye Bank, Murray, Utah, USA
| | - Rachel Huynh
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James H Ellis
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Viberg A, Westin IM, Golovleva I, Byström B. TCF4 trinucleotide repeat expansion in Swedish cases with Fuchs' endothelial corneal dystrophy. Acta Ophthalmol 2021; 100:541-548. [PMID: 34644448 DOI: 10.1111/aos.15032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Fuchs' endothelial corneal dystrophy (FECD) has been considered a genetically heterogeneous disease but is increasingly associated with the transcription factor 4 (TCF4) gene. This study investigates the prevalence of the cytosine-thymine-guanine (CTG)n repeat expansion in TCF4 among FECD patients in northern Sweden coupled to the phenotype. METHODS Blood samples were collected from 85 FECD cases at different stages. Short tandem repeat PCR and triplet repeat-primed PCR were applied in order to determine TCF4 (CTG)n genotype. RESULTS A (CTG)n repeat expansion (n > 50) in TCF4 was identified in 76 of 85 FECD cases (89.4%) and in four of 102 controls (3.9%). The median (CTG)n repeat length was 81 (IQR 39.3) in mild FECD and 87 (IQR 13.0) in severe FECD (p = 0.01). A higher number of (CTG)n repeats in an expanded TCF4 allele increased the probability of severe FECD. Other ocular surgery was overrepresented in FECD cases without a (CTG)n repeat expansion (44.4%, n = 4) compared with 3.9% (n = 3) in FECD cases with an (CTG)n repeat expansion (p < 0.001). CONCLUSION In northern Sweden, the FECD phenotype is associated with (CTG)n expansion in the TCF4 gene, with nearly 90% of patients being hetero- or homozygous for (CTG)n expansion over 50 repeats. Furthermore, the severity of FECD was associated with the repeat length in the TCF4 gene. Ocular surgery might act as an environmental factor explaining the clinical disease in FECD without a repeat expansion in TCF4.
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Affiliation(s)
- Andreas Viberg
- Department of Clinical Sciences/Ophthalmology Umeå University Umeå Sweden
| | - Ida Maria Westin
- Department of Medical Biosciences/Medical and Clinical Genetics Umeå University Umeå Sweden
| | - Irina Golovleva
- Department of Medical Biosciences/Medical and Clinical Genetics Umeå University Umeå Sweden
| | - Berit Byström
- Department of Clinical Sciences/Ophthalmology Umeå University Umeå Sweden
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Incidence of corneal transplantation after challenging cataract surgery in patients with and without corneal guttata. J Cataract Refract Surg 2021; 47:358-365. [PMID: 33086292 DOI: 10.1097/j.jcrs.0000000000000451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To study the risk for corneal transplantation after phacoemulsification with dense cataract or posterior capsule rupture (PCR) and the impact of corneal guttata. SETTING Forty-nine Swedish cataract surgical units and 8 Swedish cornea transplantation units. DESIGN Registry-based cohort study. METHODS Patient data from the Swedish National Cataract Registry (2010 to 2012) were linked with data from the Swedish Cornea Transplant Registry (2010 to 2017). The outcome measures were risk for future corneal transplantation, visual acuity, and self-assessed visual function after phacoemulsification. Logistic and Poisson regression analyses with adjustment for confounder effects were used to investigate the association of the outcome measures with dense cataract, indicated by trypan blue capsular staining (TB) and PCR, separately and together. RESULTS Altogether, data from 276 362 cataract patients were linked with data from 2091 patients with endothelial failure who underwent corneal transplantation.The risk for future corneal transplantation increased more than 3-fold with the presence of dense cataract or PCR, and a trend toward an ever-higher risk with the combination of TB and PCR together, but without any significant synergy of corneal guttata. Dense cataract, but not PCR, was significantly associated with an increased probability of inferior visual acuity after phacoemulsification. The impact on satisfaction was not statistically significant for any of the factors. CONCLUSIONS Challenging cataract surgery increases the risk for future corneal transplantation equally in patients both with and without corneal guttata, despite a more vulnerable endothelium in the guttata group. This supports a strategy where PCR is limited and handled optimally and that cataract surgery is performed before the cataract turns critically dense.
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Chuckpaiwong V, Muakkul S, Phimpho P, Lekhanont K, Jongkhajornpong P. Incidence and Risk Factors of Corneal Endothelial Failure after Phacoemulsification in Patients with Fuchs Endothelial Corneal Dystrophy: A 13-Year Retrospective Cohort. Clin Ophthalmol 2021; 15:2367-2373. [PMID: 34113080 PMCID: PMC8187099 DOI: 10.2147/opth.s315436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
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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Affiliation(s)
- Varintorn Chuckpaiwong
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasin Muakkul
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prae Phimpho
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Passara Jongkhajornpong
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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