Preoperative Risk Assessment for Progression to Descemet Membrane Endothelial Keratoplasty Following Cataract Surgery in Fuchs Endothelial Corneal Dystrophy
To identify preoperative corneal tomographic features that predict progression to endothelial keratoplasty (EK) following cataract surgery in Fuchs endothelial corneal dystrophy (FECD) and establish a regression model to identify high-risk patients. Prospective, observational cohort study. Setting:...
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Veröffentlicht in: | American journal of ophthalmology 2019-12, Vol.208, p.76-86 |
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creator | Arnalich-Montiel, Francisco Mingo-Botín, David De Arriba-Palomero, Pablo |
description | To identify preoperative corneal tomographic features that predict progression to endothelial keratoplasty (EK) following cataract surgery in Fuchs endothelial corneal dystrophy (FECD) and establish a regression model to identify high-risk patients.
Prospective, observational cohort study.
Setting: Hospital Universitario Ramón y Cajal, Madrid, Spain. Study Population: Sixty-eight patients (84 eyes) with FECD who underwent phacoemulsification. Intervention: We assessed preoperative best-corrected visual acuity; ultrasound central corneal thickness; pachymetric, anterior chamber depth, and corneal backscatter variables using Scheimpflug imaging; and endothelial cell density. Main Outcome Measures: Progression to EK.
A total of 33 eyes (39.3%) needed EK after phacoemulsification to rehabilitate vision. On multivariate analysis, anterior layer (AL) corneal backscatter between 0 and 2 mm from the apex and relative increase in central corneal thickness from the “relative pachymetry display” by the Pentacam were significant predictors of the risk of progression to EK. Using these 2 variables, a risk score (RISC score) was derived from the regression model (area under the curve = 0.973; best cutoff point with a specificity of 95% representing a sensitivity of 96%). Excluding corneal backscatter data from the multivariate regression model, corneal thickness at the pupil center by the Pentacam and relative increase in central corneal thickness were significant predictors and provided a modified risk score (RIPT score) with similar performance.
Both scores demonstrated accuracy in predicting progression to EK using easily accessible preoperative data. This approach, which can be readily implemented by surgeons, allows for individualized risk assessment. |
doi_str_mv | 10.1016/j.ajo.2019.07.012 |
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Prospective, observational cohort study.
Setting: Hospital Universitario Ramón y Cajal, Madrid, Spain. Study Population: Sixty-eight patients (84 eyes) with FECD who underwent phacoemulsification. Intervention: We assessed preoperative best-corrected visual acuity; ultrasound central corneal thickness; pachymetric, anterior chamber depth, and corneal backscatter variables using Scheimpflug imaging; and endothelial cell density. Main Outcome Measures: Progression to EK.
A total of 33 eyes (39.3%) needed EK after phacoemulsification to rehabilitate vision. On multivariate analysis, anterior layer (AL) corneal backscatter between 0 and 2 mm from the apex and relative increase in central corneal thickness from the “relative pachymetry display” by the Pentacam were significant predictors of the risk of progression to EK. Using these 2 variables, a risk score (RISC score) was derived from the regression model (area under the curve = 0.973; best cutoff point with a specificity of 95% representing a sensitivity of 96%). Excluding corneal backscatter data from the multivariate regression model, corneal thickness at the pupil center by the Pentacam and relative increase in central corneal thickness were significant predictors and provided a modified risk score (RIPT score) with similar performance.
Both scores demonstrated accuracy in predicting progression to EK using easily accessible preoperative data. This approach, which can be readily implemented by surgeons, allows for individualized risk assessment.</description><identifier>ISSN: 0002-9394</identifier><identifier>EISSN: 1879-1891</identifier><identifier>DOI: 10.1016/j.ajo.2019.07.012</identifier><identifier>PMID: 31369719</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anterior Chamber - pathology ; Cataracts ; Cornea ; Corneal Pachymetry ; Descemet Stripping Endothelial Keratoplasty ; Diabetic retinopathy ; Disease Progression ; Edema ; Eye surgery ; Female ; Fuchs' Endothelial Dystrophy - diagnosis ; Fuchs' Endothelial Dystrophy - etiology ; Fuchs' Endothelial Dystrophy - surgery ; Humans ; Lens Implantation, Intraocular ; Male ; Middle Aged ; Ophthalmology ; Patients ; Phacoemulsification - adverse effects ; Preoperative Period ; Prospective Studies ; Risk Assessment ; Software ; Visual Acuity - physiology</subject><ispartof>American journal of ophthalmology, 2019-12, Vol.208, p.76-86</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-2013db3267a68f5a527471ed663b4991d8563c2518fa0f6cd8ea30d11cdf9bfb3</citedby><cites>FETCH-LOGICAL-c381t-2013db3267a68f5a527471ed663b4991d8563c2518fa0f6cd8ea30d11cdf9bfb3</cites><orcidid>0000-0002-1229-2018</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ajo.2019.07.012$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31369719$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arnalich-Montiel, Francisco</creatorcontrib><creatorcontrib>Mingo-Botín, David</creatorcontrib><creatorcontrib>De Arriba-Palomero, Pablo</creatorcontrib><title>Preoperative Risk Assessment for Progression to Descemet Membrane Endothelial Keratoplasty Following Cataract Surgery in Fuchs Endothelial Corneal Dystrophy</title><title>American journal of ophthalmology</title><addtitle>Am J Ophthalmol</addtitle><description>To identify preoperative corneal tomographic features that predict progression to endothelial keratoplasty (EK) following cataract surgery in Fuchs endothelial corneal dystrophy (FECD) and establish a regression model to identify high-risk patients.
Prospective, observational cohort study.
Setting: Hospital Universitario Ramón y Cajal, Madrid, Spain. Study Population: Sixty-eight patients (84 eyes) with FECD who underwent phacoemulsification. Intervention: We assessed preoperative best-corrected visual acuity; ultrasound central corneal thickness; pachymetric, anterior chamber depth, and corneal backscatter variables using Scheimpflug imaging; and endothelial cell density. Main Outcome Measures: Progression to EK.
A total of 33 eyes (39.3%) needed EK after phacoemulsification to rehabilitate vision. On multivariate analysis, anterior layer (AL) corneal backscatter between 0 and 2 mm from the apex and relative increase in central corneal thickness from the “relative pachymetry display” by the Pentacam were significant predictors of the risk of progression to EK. Using these 2 variables, a risk score (RISC score) was derived from the regression model (area under the curve = 0.973; best cutoff point with a specificity of 95% representing a sensitivity of 96%). Excluding corneal backscatter data from the multivariate regression model, corneal thickness at the pupil center by the Pentacam and relative increase in central corneal thickness were significant predictors and provided a modified risk score (RIPT score) with similar performance.
Both scores demonstrated accuracy in predicting progression to EK using easily accessible preoperative data. This approach, which can be readily implemented by surgeons, allows for individualized risk assessment.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anterior Chamber - pathology</subject><subject>Cataracts</subject><subject>Cornea</subject><subject>Corneal Pachymetry</subject><subject>Descemet Stripping Endothelial Keratoplasty</subject><subject>Diabetic retinopathy</subject><subject>Disease Progression</subject><subject>Edema</subject><subject>Eye surgery</subject><subject>Female</subject><subject>Fuchs' Endothelial Dystrophy - diagnosis</subject><subject>Fuchs' Endothelial Dystrophy - etiology</subject><subject>Fuchs' Endothelial Dystrophy - surgery</subject><subject>Humans</subject><subject>Lens Implantation, Intraocular</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Ophthalmology</subject><subject>Patients</subject><subject>Phacoemulsification - adverse effects</subject><subject>Preoperative Period</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Software</subject><subject>Visual Acuity - physiology</subject><issn>0002-9394</issn><issn>1879-1891</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhSMEokPhAdggS2zYJPjGiROLVTXtAKKIip-15Tg3Mw5JnNpOUd6Fh8WjKUiwYHV1re8c-dyTJM-BZkCBv-4z1dsspyAyWmUU8gfJBupKpFALeJhsKKV5KpgozpIn3vdx5VVRPU7OGDAuKhCb5OeNQzujU8HcIfls_Hdy4T16P-IUSGcduXF27-KDsRMJllyi1zhiIB9xbJyakFxNrQ0HHIwayIejk50H5cNKdnYY7A8z7clWBeWUDuTL4vboVmImslv0wf8l3lo3YZyXqw_Ozof1afKoU4PHZ_fzPPm2u_q6fZdef3r7fntxnWpWQ0jjAVjbsJxXitddqco8pgRsOWdNIQS0dcmZzkuoO0U7rtsaFaMtgG470XQNO09enXxnZ28X9EGOJqYchhjPLl7mOa8ZFMBZRF_-g_Z2cVP8ncwZCChLUeSRghOlnfXeYSdnZ0blVglUHquTvYzVyWN1klYyVhc1L-6dl2bE9o_id1cReHMCMJ7izqCTXhucNLbGoQ6yteY_9r8AtZSsYQ</recordid><startdate>201912</startdate><enddate>201912</enddate><creator>Arnalich-Montiel, Francisco</creator><creator>Mingo-Botín, David</creator><creator>De Arriba-Palomero, Pablo</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1229-2018</orcidid></search><sort><creationdate>201912</creationdate><title>Preoperative Risk Assessment for Progression to Descemet Membrane Endothelial Keratoplasty Following Cataract Surgery in Fuchs Endothelial Corneal Dystrophy</title><author>Arnalich-Montiel, Francisco ; Mingo-Botín, David ; De Arriba-Palomero, Pablo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-2013db3267a68f5a527471ed663b4991d8563c2518fa0f6cd8ea30d11cdf9bfb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anterior Chamber - pathology</topic><topic>Cataracts</topic><topic>Cornea</topic><topic>Corneal Pachymetry</topic><topic>Descemet Stripping Endothelial Keratoplasty</topic><topic>Diabetic retinopathy</topic><topic>Disease Progression</topic><topic>Edema</topic><topic>Eye surgery</topic><topic>Female</topic><topic>Fuchs' Endothelial Dystrophy - diagnosis</topic><topic>Fuchs' Endothelial Dystrophy - etiology</topic><topic>Fuchs' Endothelial Dystrophy - surgery</topic><topic>Humans</topic><topic>Lens Implantation, Intraocular</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Ophthalmology</topic><topic>Patients</topic><topic>Phacoemulsification - adverse effects</topic><topic>Preoperative Period</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Software</topic><topic>Visual Acuity - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arnalich-Montiel, Francisco</creatorcontrib><creatorcontrib>Mingo-Botín, David</creatorcontrib><creatorcontrib>De Arriba-Palomero, Pablo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arnalich-Montiel, Francisco</au><au>Mingo-Botín, David</au><au>De Arriba-Palomero, Pablo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Risk Assessment for Progression to Descemet Membrane Endothelial Keratoplasty Following Cataract Surgery in Fuchs Endothelial Corneal Dystrophy</atitle><jtitle>American journal of ophthalmology</jtitle><addtitle>Am J Ophthalmol</addtitle><date>2019-12</date><risdate>2019</risdate><volume>208</volume><spage>76</spage><epage>86</epage><pages>76-86</pages><issn>0002-9394</issn><eissn>1879-1891</eissn><abstract>To identify preoperative corneal tomographic features that predict progression to endothelial keratoplasty (EK) following cataract surgery in Fuchs endothelial corneal dystrophy (FECD) and establish a regression model to identify high-risk patients.
Prospective, observational cohort study.
Setting: Hospital Universitario Ramón y Cajal, Madrid, Spain. Study Population: Sixty-eight patients (84 eyes) with FECD who underwent phacoemulsification. Intervention: We assessed preoperative best-corrected visual acuity; ultrasound central corneal thickness; pachymetric, anterior chamber depth, and corneal backscatter variables using Scheimpflug imaging; and endothelial cell density. Main Outcome Measures: Progression to EK.
A total of 33 eyes (39.3%) needed EK after phacoemulsification to rehabilitate vision. On multivariate analysis, anterior layer (AL) corneal backscatter between 0 and 2 mm from the apex and relative increase in central corneal thickness from the “relative pachymetry display” by the Pentacam were significant predictors of the risk of progression to EK. Using these 2 variables, a risk score (RISC score) was derived from the regression model (area under the curve = 0.973; best cutoff point with a specificity of 95% representing a sensitivity of 96%). Excluding corneal backscatter data from the multivariate regression model, corneal thickness at the pupil center by the Pentacam and relative increase in central corneal thickness were significant predictors and provided a modified risk score (RIPT score) with similar performance.
Both scores demonstrated accuracy in predicting progression to EK using easily accessible preoperative data. This approach, which can be readily implemented by surgeons, allows for individualized risk assessment.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31369719</pmid><doi>10.1016/j.ajo.2019.07.012</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-1229-2018</orcidid></addata></record> |
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subjects | Aged Aged, 80 and over Anterior Chamber - pathology Cataracts Cornea Corneal Pachymetry Descemet Stripping Endothelial Keratoplasty Diabetic retinopathy Disease Progression Edema Eye surgery Female Fuchs' Endothelial Dystrophy - diagnosis Fuchs' Endothelial Dystrophy - etiology Fuchs' Endothelial Dystrophy - surgery Humans Lens Implantation, Intraocular Male Middle Aged Ophthalmology Patients Phacoemulsification - adverse effects Preoperative Period Prospective Studies Risk Assessment Software Visual Acuity - physiology |
title | Preoperative Risk Assessment for Progression to Descemet Membrane Endothelial Keratoplasty Following Cataract Surgery in Fuchs Endothelial Corneal Dystrophy |
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