Repeat surgical interventions in non-Fuchs corneal dystrophies: insights from eight decades of histopathological and clinical data

Abstract Background/Objectives To evaluate the proportion of specimens and patients linked to surgical re-interventions and the types of preceding procedures in non-Fuchs corneal dystrophies using an eight-decade dataset. Subjects/Methods A total of 372 histopathological specimens with confirmed diagnoses of non-Fuchs corneal dystrophies, collected between 1945 and 2024, were retrospectively examined with associated clinical data. The proportion of re-interventions was assessed on both a per-specimen and per-patient basis by dystrophy type. For each of the 94 re-intervention specimens, the type of prior procedure leading to re-intervention, including manual superficial keratectomy (MSK), phototherapeutic keratectomy (PTK), penetrating keratoplasty (PKP) and limbo-keratoplasty (LimboKP), was analysed. Results Gelatinous drop-like dystrophy (GDLD) showed the highest proportion of specimens obtained after surgical re-intervention (86.2%), including specimens following LimboKP (13/25). Granular dystrophy (GCD) and lattice dystrophy (LCD) also accounted for high proportions of re-intervention specimens (39.2% and 32.8%, respectively), most following PKP (16/31 and 17/21, respectively). In contrast, macular corneal dystrophy (MCD), showed a low proportion of re-interventions per specimen (4.6%) with all specimens linked to minimally invasive techniques. No re-interventions were observed in endothelial dystrophies. Conclusions Surgical re-intervention is frequent in epithelial and epithelial-stromal dystrophies, particularly GDLD, GCD and LCD, and may occur even after targeted procedures like LimboKP. In contrast, stromal dystrophies like MCD rarely required repeat surgery, especially following PKP. These findings highlight the limitations of current surgical approaches in recurrence-prone dystrophies and support the need for dystrophy-specific strategies, including the development of improved techniques to reduce recurrence and the implementation of risk-adapted follow-up.