A risk prediction model for endothelial keratoplasty after uncomplicated cataract surgery in Fuchs endothelial corneal dystrophy.

PURPOSE: To develop a risk prediction model for endothelial keratoplasty (EK) after uncomplicated cataract surgery in Fuchs endothelial corneal dystrophy (FECD) using Scheimpflug imaging.

DESIGN: Prospective, observational cohort study.

METHODS: The study was conducted at the Ramón y Cajal University Hospital (Madrid, Spain) on 127 eyes from 93 consecutive patients with vision loss, FECD, and cataracts.

OBSERVATION: We assessed the corneas using Scheimpflug imaging pachymetry and elevation maps for loss of regular isopachs, displacement of the thinnest point, and posterior surface depression according to the Mayo Clinic subclinical corneal edema classification. We also recorded other preoperative data.

PRIMARY ENDPOINTS: The primary endpoint was the need for EK after uncomplicated phacoemulsification within 2 years (median duration, 18 months). We calculated the risk using hazard ratios and the Kaplan-Meier cumulative Incidence risk.

RESULTS: Forty-four participants required EK, and those eyes with 1, 2 or all 3 tomographic features had a hazard risk of 21.8, 57.2 and 76.5, respectively (p<.005) compared with those eyes with normal tomographic patterns. The best predictive model was based on the number of tomographic features simultaneously present in an eye and the central corneal thickness at the pupillary center. We aimed to develop a risk score from 0 to 8. The cumulative risk for EK ranged from virtually 0 for risk scores <4 to almost 100% for those with a score of 8.

CONCLUSIONS: The combination of CCT values and tomographic features can be employed to make valid predictions of the risk of requiring EK after phacoemulsification.