ArticleEye and vision (London, England)2026
Validation and extension of the SUCCESS score for Fuchs dystrophy after cataract surgery.
Article in Eye and vision (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
Abstract
backgroundAccurate preoperative identification of patients with Fuchs endothelial corneal dystrophy (FECD) who are at risk of requiring endothelial keratoplasty (EK) after cataract surgery remains challenging. The SUbClinical Corneal Edema Scheimpflug Study (SUCCESS) score was previously developed to estimate this risk using Scheimpflug tomography. We aimed to prospectively and externally validate the SUCCESS score in an independent multicenter cohort and determine whether the incorporation of corneal densitometry improves predictive performance and clinical utility.
methodsIn this prospective multicenter cohort study, 207 eyes from 177 patients with FECD grade ≥ 2 and visually significant cataract were enrolled across six tertiary hospitals in Spain (June 2020 to October 2024), with follow-up through May 2025. After predefined exclusions, 178 eyes (149 patients) were analyzed. The original SUCCESS score was used without recalibration. An extended model incorporated peak mean corneal densitometry within the central 3-mm zone. Time-to-event analyses were performed using Cox proportional hazards models. Discrimination, calibration, reclassification, and clinical utility were assessed using Harrell's C-index, Brier score, net reclassification index (NRI), integrated discrimination improvement (IDI), and decision curve analysis.
resultsOver a median follow-up of 37.0 months (interquartile range [IQR], 10.1-45.9), 38 eyes (21%) met the criteria for EK, with 82% of events occurring within 6 months after phacoemulsification. The original SUCCESS score demonstrated good discrimination (C-index = 0.80; 95% confidence interval [CI], 0.73-0.86) with slight underestimation of absolute risk (predicted 16.4% vs. observed 21.6%). Incorporation of corneal densitometry improved discrimination (C-index = 0.85; 95% CI, 0.79-0.90; ΔC = + 0.05; P = 0.0047), reduced prediction error (ΔBrier = - 0.019; P < 0.001), and enhanced risk reclassification (NRI = 0.39; 95% CI, 0.14-0.64; P = 0.002), including correct upward reclassification of 26% of eyes requiring EK. The extended model provided greater net benefit at relevant decision thresholds (25%-50%).
conclusionsIn this multicenter external validation study, the SUCCESS score demonstrated a robust performance in predicting postoperative EK in FECD. The addition of corneal densitometry provided incremental improvements in discrimination and clinically meaningful risk stratification, particularly in intermediate-risk cases. Standardized Scheimpflug-based risk assessment may support individualized surgical planning and referral decisions.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.