Refractive Outcomes in Fuchs’ Endothelial Corneal Dystrophy: Conventional and Femtosecond Laser-Assisted Cataract Surgery

Figures & data

Table 1 Baseline Characteristics in Risk Factor Analysis^€ for Fuchs Endothelial Corneal Dystrophy Patients

Laser Treatment	Femtosecond Laser	Conventional	Generalized Estimating Equation (GEE) Model P- value
Number of Patients	52	123
Number of Eyes for Analyses	73	146
Age (y), mean age ± SD	74.1 ± 7.5	75.2 ± 8.5	0.58
Best-corrected visual acuity, Mean logMAR (BCVA) ± SD [Range]	0.231 ± 0.163	0.331 ± 0.264	0.001
Visual Acuity Group, N (%)			0.024
≥ 20/30	40 (56)	60 (41)
20/30 – 60	30 (42)	62 (43)
20/70 – 5/200	2 (3)	24 (16)
Central corneal thickness (μm)^Φ, mean ± SD [Range]	576 ± 39 [496, 623]	574 ± 39 [496, 648]	0.81
Not collected N, (%)	55 (75)	83 (57)	0.038
Collected N, (%)	18 (25)	63 (43)
Gender N, (%)			0.83
Male	21 (29)	48 (33)
Female	52 (71)	98 (67)
Corneal guttata grade N, (%)			0.67
0.5–1.0	16 (24)	42 (33)
1.5 −2.0	24 (36)	38 (30)
2.5–3.0	22 (33)	35 (28)
3.5–4.0	5 (8)	12 (9)
Cataract grade N, (%)			0.16
0.5–1.0	7 (10)	5 (4)
1.5−2.0	34 (49)	84 (58)
2.5–3.0	29 (41)	52 (36)
3.5–4.0	0	3 (2)
Target refractions			0.005
Mean (SD)	−0.3 (0.3)	−0.1 (0.1)
[Range]	[−2, 0]	[−3, 0]

Notes: ^ΦPreoperative central corneal thickness was not available for every patient; values were calculated from n = 18 (femtosecond laser) and n = 63 (conventional); ^€Tabled samples sizes are based on all eyes with early follow-up data at 1–6 weeks and/or late follow-up data at 3–12 months.

Table 2 Eyes with Early (1–6 Weeks) Postoperative Follow-Up

Eyes with Early (1–6 Week) Postoperative Follow-Up
	Femtosecond	Conventional	Total	GEE p-value
N Eyes	70	134	204
Preoperative Spherical Equivalent, Mean ± SD [range]	N/A	N/A	N/A	N/A
Preoperative logMAR BCVA Mean ± SD [range]	0.23 ± 0.17 [0, 1.0]	0.32 ± 0.26 [−0.1, 1.6]	0.29 ± 0.24 [−0.1, 1.6]	0.003
Preoperative Acuity Group, N (%)				0.042
≥ 20/30	38 (55%)	57 (43%)	95 (47%)
60	29 (42%)	56 (42%)	85 (42%)
20/70 – 5/200	2 (3%)	21 (16%)	23 (11%)
Early Postoperative Spherical Equivalent, target corrected (SETC)
SETC, Mean ± SD [range]	−0.07± 0.89 [−2.00, 2.75]	−0.11 ± 0.80 [−2.63, 3.25]	−0.10 ± 0.83 [−2.63, 3.25]	0.78
Absolute value SETC, Mean ± SD [range]	0.66 ± 0.60 [0, 2.75]	0.56 ± 0.58 [0, 3.25]	0.60 ± 0.59 [0, 3.25]	0.25
Outcome classification by deviation from target refraction, N (%)				0.24
Good (≤0.5D)	39 (56%)	87 (65%)	126 (62%)
Fair (>0.5 to ≤1D)	19 (27%)	25 (19%)	44 (22%)
Poor (>1D)	12 (17%)	22 (16%)	34 (17%)
Early Postoperative Visual acuity
logMAR BCVA Mean ± SD [range]	0.14 ± 0.14 [0, 0.7]	0.17 ± 0.25 [−0.1, 2.0]	0.16 ± 0.22 [−0.1, 2.0]	0.18
Visual Acuity Group				0.29
≥ 20/30	57 (81%)	97 (73%)	154 (76%)
20/30 – 60	12 (17%)	28 (21%)	40 (20%)
20/70 – 5/200	1 (1%)	8 (6%)	9 (4%)

Table 3 Eyes with Late Postoperative Follow-Up (3–12 Months)

	Femtosecond	Conventional	Total	GEE p-value
N Eyes	50	88	138
Preoperative Spherical Equivalent, Mean ± SD [range]	N/A	N/A	N/A	N/A
Preoperative logMAR BCVA Mean ± SD [range]	0.21 ± 0.16 [0, 1.0]	0.40 ± 0.29 [0, 1.6]	0.33 ± 0.27 [0, 1.6]	P<0.001
Preoperative Acuity Group, N (%)				0.001
≥ 20/30	31 (63%)	24 (27%)	55 (40%)
20/30 – 60	17 (35%)	44 (50%)	61 (45%)
20/70 – 5/200	1 (2%)	20 (23%)	21 (15%)
Postoperative Spherical Equivalent, target corrected (SETC)
SETC, Mean ± SD [range]	−0.10 ± 0.68 [−2.00, 2.25]	−0.15 ± 0.94 [−2.13, 2.75]	−0.14 ± 0.85 [−2.13, 2.75]	0.47
Absolute value SETC, Mean ± SD [range]	0.51 ± 0.46 [0. 2.25]	0.70 ± 0.64 [0, 2.75]	0.63 ± 0.59 [0, 2.75]	0.29
Outcome classification by deviation from target refraction, N (%)				0.11
Good (≤0.5D)	34 (68%)	51 (58%)	85 (62%)
Fair (>0.5 to ≤1D)	11 (22%)	15 (17%)	26 (19%)
Poor (>1D)	5 (10%)	22 (25%)	27 (20%)

Figure 1 Spherical equivalent outcome by type of cataract surgery for early follow period (A) and late follow-up period 9 (B).

Figure 2 Spherical Equivalent drift from early-to-late follow-up period by cataract surgery type.

Table 4 Preoperative Risk Factors for Poor Outcome (>1D from Target Refraction)

	Follow Up Period
	Early	Late
Number of Eyes	204	138
N (%) of eyes with poor outcome	34 (17%)	27 (20%)
Risk factor	Odds ratio (95% CI) * ^†
Age (10 years older age)	0.97 (0.62, 1.51) P=0.88	0.75 (0.46, 1.22) P=0.24
Best-corrected visual acuity (0.3 worse logMAR acuity	1.17 (0.74, 1.85) P=0.50	1.46 (0.92, 2.31) P=0.11
CCT (if measured, 50um thicker)	1.09 (0.46, 2.59) P=0.84	0.84 (0.32, 2.18) P=0.84
Gender	P=0.52	P=0.89
Male	0.76 (0.33, 1.76)	0.94 (0.38, 2.34)
Female	Reference	Reference
Visual Acuity Group, N (%)	P=0.98	P=0.13
≥ 20/30	Reference	Reference
20/30 – 60	0.94 (0.44, 2.01)	1.23 (0.43, 3.52)
20/70 – 5/200	1.02 (0.31, 3.33)	3.32 (0.87, 11.3)
Central corneal measured	P=0.66	P=0.86
Yes	1.19 (0.55, 2.57)	1.08 (0.46, 2.56)
No	Reference	Reference
Corneal guttata grade N, (%)	P=0.97	P=0.84
0.5–1.0	Reference	Reference
1.5−2.0	1.16 (0.43, 3.15)	1.96 (0.44, 8.69)
2.5–3.0	0.95 (0.34, 2.61)	1.25 (0.32, 4.88)
3.5–4.0	0.92 (0.18, 4.78)	1.40 (0.44, 4.46)
Cataract grade N, (%)	P<0.001	0.90
0.5–1.0	Reference	Reference
1.5−2.0	1.32 (0.29, 6.05)	1.21 (0.25, 5.95)
2.5–3.0	0.89 (0.17, 4.69)	1.44 (0.26, 8.17)
3.5–4.0	5.73 (1.32, 24.9)	None present
Target refraction (D)	P=0.75	P=0.47
>-0.5	Reference	Reference
−0.75, −0.5	0.94 (0.34, 2.60)	0.45 (0.13, 1.60)
≤ −1.0	1.58 (0.46, 5.38)	(0.87 (0.17, 4.40)

Notes: *Univariate GEE, not adjusted for type of laser treatment; ^†Reference = Odds ratio reference category.

Table 5 Refractive Outcomes and Postoperative Edema, Early Postoperative Period

Refractive Outcome	Absence of Postoperative Edema	Presence of Postoperative Edema
Good	61 (66%)	23 (51%)
Fair	14 (15%)	10 (22%)
Poor	18 (19%)	12 (27%)

Table 6 Refractive Outcomes and Postoperative Edema, Late Postoperative Period

Refractive Outcome	Absence of Postoperative Edema	Presence of Postoperative Edema
Good	72 (63%)	12 (52%)
Fair	20 (17%)	4 (17%)
Poor	23 (20%)	7 (30%)

Table 7 Spherical Equivalence Change from Early to Late Period

	Femtosecond	Conventional	Total	GEE P-value
N	47	76	123
SE change from early to late Mean ± SD [range]	0.02 ± 0.59 [−1.25, 1.75]	−0.12 ± 1.20 [−3.50, 3.25]	−0.06 ± 1.01 [−3.50, 3.25]	0.30