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Lookup NU author(s): Dr Nik TzoumasORCiD, Professor Francisco FigueiredoORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). Background: To identify predictors of unplanned endothelial keratoplasty after phacoemulsification in Fuchs’ endothelial corneal dystrophy (FECD), and to assess postoperative best-corrected visual acuity (BCVA). Methods: Retrospective single-centre case series of 50 eyes (39 patients) that underwent soft-shell phacoemulsification and monofocal intra-ocular lens implantation by one surgeon (2015–2021). The primary outcome was unplanned corneal decompensation requiring endothelial keratoplasty. Associations with specular-microscopy parameters and central corneal thickness (CCT) were examined with penalised logistic and Cox regressions adjusted for age, sex, and hypertonic-saline use. Postoperative BCVA was analysed using linear regression models also adjusted for baseline acuity. Results: Mean age was 74 ± 8 years; 68% were women; median follow-up 32 (IQR 24–40) months. Four eyes (8%) required Descemet stripping endothelial keratoplasty a median 8 months after cataract surgery. Each 1 μm increase in pre-operative CCT raised the hazard of grafting by 2% (HR 1.02, 95% CI 1.00–1.04, P = 0.031); a threshold of ≥ 620 μm yielded an AUC of 0.91. Linear regression analyses of postoperative BCVA adjusted for preoperative BCVA showed no clear association between baseline and postoperative acuity. Conclusions: Pre-operative CCT shows the strongest association of readily available metrics with post-phaco corneal failure in FECD; values above ∼600 μm may warrant counselling regarding combined or staged keratoplasty.
Author(s): Teh BL, Tzoumas N, Boso ALM, Ang YL, Papadakou P, Figueiredo FC
Publication type: Article
Publication status: Published
Journal: European Journal of Ophthalmology
Year: 2026
Pages: Epub ahead of print
Online publication date: 18/06/2026
Acceptance date: 08/04/2026
Date deposited: 29/06/2026
ISSN (print): 1120-6721
ISSN (electronic): 1724-6016
Publisher: SAGE Publications Ltd
URL: https://doi.org/10.1177/11206721261445518
DOI: 10.1177/11206721261445518
Data Access Statement: The datasets generated and/or analysed during this study are available from the corresponding author upon reasonable request.
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