Endothelial Safety After Phacoemulsification in Patients with Fuchs Dystrophy: Short Term Outcomes and Predictors of Corneal Edema

Abstract

Objectives: To compare the clinical outcomes of phacoemulsification combined with intraocular lens implantation in patients with Fuchs endothelial corneal dystrophy (FECD) and individuals with healthy corneas. Methods: This retrospective study included eyes that underwent phacoemulsification and intraocular lens (IOL) implantation between January 2021 and September 2022. Phacoemulsification was performed using a contemporary oscillatory ultrasound mode; device-logged energy and fluidics metrics were recorded. Best corrected visual acuity (BCVA) and specular microscopy (CEM-530™; Nidek) were evaluated preoperatively and at postoperative week 1, month 1, and month 3. Endothelial cell density (ECD) and central corneal thickness (CCT) were recorded. The primary outcome measures were post-operative BCVA, ECD, and CCT changes. The study included 32 eyes with FECD and 29 control eyes with healthy corneas. Results: In both groups, mean BCVA improved significantly from 0.7 LogMAR preoperatively to 0.15 LogMAR at 1 month postoperatively (p<0.001). The endothelial cell loss at 3 months was significantly higher in the FECD group compared to controls (20.9% vs. 17.9%, p=0.022). Baseline ECD was 2065.5 cells/mm² in the FECD group and 2289.4 cells/ mm² in the control group, decreasing to 1633.1 and 1878.9 cells/mm², respectively, at 3 months. CCT increased from 564.5 µm to 584.1 µm in the FECD group (p=0.006), and from 550.5 µm to 557.7 µm in the control group (p=0.124). No cases of postoperative corneal decompensation were observed. Conclusion: Phacoemulsification yielded meaningful visual improvement in FECD eyes without early corneal decompensation. Endothelial loss was higher and CCT recovery slower than in controls, supporting energy-minimizing techniques and closer early follow-up in FECD.