Clinical manifestations after cataract surgery in patients with moderate Fuchs corneal endothelial dystrophy

Purpose: The aim of this study was to analyze the clinical outcomes of cataract surgery in patients with moderate Fuchs endothelial corneal dystrophy (FECD) in whom central endothelial cells could not be observed using specular microscopy.Methods: This retrospective study included nine eyes in seven patients diagnosed with FECD who underwent phacoemulsification at a single institution between January 2023 and November 2024. A single experienced corneal specialist performed slit-lamp examination and phacoemulsification. Best-corrected visual acuity (BCVA), specular microscopy, and central corneal thickness (CCT) measurements were performed preoperatively and postoperatively, and the outcomes were compared.Results: The mean age of the patients was 69.8±6.5 years. Three were male patients and four were female patients. The mean preoperative CCT was 559.5±51.8 μm and the mean peripheral endothelial cell density was 599.3±129.4 cells/mm2. BCVA significantly improved in all patients postoperatively, with a mean logMAR BCVA improving from 0.65±0.52 preoperatively to 0.19±0.14 postoperatively (P=0.002). The mean CCT showed no significant change (preoperative, 559.6±51.8 μm; postoperative, 566.8±45.1 μm; P=0.218). In patients with follow-up longer than 6 months, an increase in CCT was observed at 30 days postoperatively, but CCT returned to preoperative levels after 90 days.Conclusion: In patients with moderate-to-severe FECD in whom central endothelial cells cannot be measured, phacoemulsification may provide favorable visual outcomes if peripheral endothelial cells are observed and corneal edema is absent preoperatively.