Abstract
Aim: To determine whether there is an association between Fuchs endothelial corneal dystrophy (FECD) and shorter axial length (AL), shallower anterior chamber depth (ACD) and higher spherical equivalent (SE). In addition, to evaluate whether there is a correlation between AL and severity of corneal decompensation in FECD, using corneal thickness as a proxy.
 Design: Retrospective cohort study.
 Methods: This was a single-centre study conducted in a cornea clinic in Sydney, Australia. Detailed clinical measurements of 91 eyes of 50 FECD patients were compared with 110 eyes of 55 controls. Main outcome measures included AL, ACD and SE. Other outcome measures included central corneal thickness, visual acuity, intraocular pressure and keratometry.
 Results: Mean AL of FECD patients was 23.6 mm (standard deviation [SD] ±0.9 mm), compared with 24.7 mm (SD ±1.8 mm) for controls (1.1 mm difference [95% confidence interval [CI] 0.5-1.6], p < 0.001, independent sample t-test); corresponding means for ACD were 3.0 and 3.3 mm (0.32 mm difference [95%CI 0.2-0.5], p < 0.001, independent t-test). Eleven out of the 22 FECD patients with available refraction data had hypermetropic refraction compared with 16 out of 36 controls (p = 0.68, chi-squared test). The mean SE of FECD patients (+0.10D) was higher than controls (−1.33D) (1.4D difference [0.1-2.8], p = 0.04, independent t-test). No statistically significant correlation was found between AL and corneal thickness (p = 0.28, linear regression).
 Conclusion: In this retrospective cohort study, a strong association was established between FECD and small eyes, with shorter AL and shallower ACD, compared with controls. These results have important implications for surgical planning, as shorter AL and ACD in FECD patients likely contribute to their high risk of corneal decompensation following cataract surgery.
Highlights
Fuchs endothelial corneal dystrophy (FECD) is the most common corneal dystrophy and one of the leading indications for corneal transplant.[1,2] The condition is characterized by progressive loss of endothelial cells and increase in extracellular matrix deposition at the level of Descemet’s membrane.[3]
The purpose of this study is to investigate the association between FECD and axial hypermetropia and examine whether a correlation exists between shorter axial length (AL) and corneal decompensation
The mean AL of FECD patients (23.6 mm standard deviation (SD) ±0.86) was lower than controls (24.7 mm SD ±1.76), with a mean difference of 1.1 mm (t = 4.12 with 81 degrees of freedom [df], p < 0.001, independent sample t-test)
Summary
Fuchs endothelial corneal dystrophy (FECD) is the most common corneal dystrophy and one of the leading indications for corneal transplant.[1,2] The condition is characterized by progressive loss of endothelial cells and increase in extracellular matrix deposition at the level of Descemet’s membrane.[3]. Two small reports have attempted this.The first was a study of 24 patients by Pitts and Jay,[4] which suggested a tendency of FECD patients to be hypermetropic with short ALs. Only two small reports have attempted this.The first was a study of 24 patients by Pitts and Jay,[4] which suggested a tendency of FECD patients to be hypermetropic with short ALs This was supported by a non-comparative series of 23 patients by Lowenstein et al.[5] Drawbacks of this research, published over two decades ago, include the small sample size, inclusion of measurements taken post-transplant and significant proportion of subjects excluded from analysis due to absent data. These studies used applanation ultrasound biometry for AL and anterior chamber depth (ACD) measurements. Non-contact optical biometry has since surpassed ultrasonography as the gold standard technique for biometric parameters, facilitating more accurate and reproducible measurements.[6,7] optical biometry has been found to be superior in eyes with short ALs, where there is potential for corneal compression with applanation ultrasound.[8]
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