Predictive biomarkers for the prognosis of phacoemulsification and posterior chamber intraocular lens implantation in Fuchs endothelial corneal dystrophy

Background: To investigate the clinical outcomes and related risk factors following phacoemulsification and posterior chamber intraocular lens implantation (PE & PCL) in East Asian patients with Fuchs endothelial corneal dystrophy (FECD). Methods: One hundred eighty eyes of 112 FECD patients who underwent PE & PCL at a tertiary hospital in Korea were included. Demographic and ocular biometric characteristics including best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were collected. Risk factors were analyzed for (1) Descemet membrane endothelial keratoplasty (DMEK) requirement and (2) postoperative BCVA < 0.5, using univariate and multivariate regression analyses and receiver operating characteristic curves. Results: Mean LogMAR BCVA improved from 0.51 to 0.20, CCT increased by 2.6% from baseline, and ECD decreased by 14.6% (all P < 0.05). Ten eyes (5.6%) underwent subsequent DMEK within three months. Baseline CCT was a risk factor for the need for DMEK (odds ratio 1.58, P < 0.05) with a cutoff value of 620 μm, achieving 100% sensitivity and 91% specificity. Baseline BCVA, CCT, and ECD predicted limited postoperative BCVA (all P < 0.05), with cutoff values of 0.35 logMAR (91% sensitivity and 59% specificity), 584 μm (57% sensitivity and 82% specificity), and 1244 cells/mm² (65% sensitivity and 77% specificity), respectively. Conclusions: In our cohort of Korean FECD eyes that underwent routine PE & PCL, progression to DMEK in the early postoperative period was relatively low. Baseline CCT values provide strong predictive power for both the necessity of DMEK and the likelihood of visual improvement after surgery.