Evidence map›Paper›PMID 40022251›Full record

ArticleEye and vision (London, England)2025

Preoperative edema severity affects outcomes after Descemet membrane endothelial keratoplasty for Fuchs endothelial corneal dystrophy: a cohort study.

Maximilian Friedrich, Hyeck-Soo Son, Jasper Lind, Maximilian Hammer, Lizaveta Chychko, Timur Mert Yildirim, Gerd Uwe Auffarth, Victor Aristide Augustin

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Eye and vision (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Prevalence of anterior corneal scars impairing visual acuity after Descemet membrane endothelial keratoplasty (DMEK) and treatment by phototherapeutic keratectomy (PTK).Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Maximilian FriedrichDepartment of Ophthalmology, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Hyeck-Soo SonDepartment of Ophthalmology, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Jasper LindDepartment of Ophthalmology, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Maximilian HammerDepartment of Ophthalmology, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Lizaveta ChychkoDepartment of Ophthalmology, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Timur Mert YildirimDepartment of Ophthalmology, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Gerd Uwe AuffarthDepartment of Ophthalmology, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Victor Aristide AugustinDepartment of Ophthalmology, David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. Victor.Augustin@med.uni-heidelberg.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn patients with Fuchs endothelial corneal dystrophy (FECD), the most beneficial stage to perform Descemet membrane endothelial keratoplasty (DMEK) remains uncertain. The goal of this study was to compare the surgical outcomes after DMEK in FECD patients with subclinical corneal edema and clinical corneal edema to test the hypothesis of whether performing surgery in subclinical corneal edema stages achieves better surgical outcomes.

methodsIn this prospective, observational, single-institution cohort study, 106 pseudophakic eyes of 85 patients with FECD were divided into two groups depending on the presence of preoperative subclinical and clinical corneal edema. Subclinical corneal edema was diagnosed if more than one of the following criteria was present in Scheimpflug tomography: loss of regular isopachs, displacement of the thinnest point of the cornea, and focal posterior corneal surface depression. Clinical corneal edema was diagnosed with slit-lamp biomicroscopy. The primary outcome was the corrected distance visual acuity (CDVA) 4 months after DMEK. Secondary outcomes were central corneal thickness (CCT), thinnest corneal thickness (TCT), and total corneal density (TCD) in Scheimpflug tomography, as well as endothelial cell loss (ECL) and the re-bubbling rate. The differences between both groups were analyzed using clustered Wilcoxon rank-sum tests or a Chi-squared test.

resultsPostoperative CDVA was significantly better in the group with subclinical edema (0.18 ± 0.12 logMAR) compared to the group with clinical edema (0.24 ± 0.19 logMAR; P = 0.026). Four months after DMEK, TCD was higher in the group with preoperative clinical edema [31.7 ± 8.3 gray scale units (GSU)] compared to the group with subclinical edema (27.8 ± 6.1 GSU; P = 0.005). The postoperative CCT, TCT, ECL, and re-bubbling rates did not differ significantly between both groups (all P > 0.05).

conclusionsDMEK for FECD yielded better visual acuity after 4 months when performed in the early stage of FECD compared to a later stage with clinical edema. This may be attributable to persistent corneal fibrosis after DMEK in eyes with preoperative clinically evident corneal edema, as suggested by higher postoperative corneal density in eyes with clinical edema. Consequently, the findings advocate for the consideration of earlier DMEK in FECD patients to achieve better surgical recovery.

Indexed as

DensitometryDescemet membrane endothelial keratoplastyDMEKFuchs endothelial corneal dystrophySubclinical corneal edema

Identifiers

PMID40022251
PMCPMC11871603

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.