The impact of overlooked Fuchs' Endothelial Corneal Dystrophy: postoperative results following intraocular interventions.

PURPOSE: To evaluate postoperative outcomes in patients with previously unrecognized Fuchs endothelial corneal dystrophy (FECD) following intraocular surgery and to identify clinical, endothelial, and tomographic features associated with delayed diagnosis and corneal decompensation. METHODS: This retrospective observational study included patients who underwent intraocular surgery without a preoperative diagnosis of FECD and were subsequently referred for persistent postoperative corneal edema. Demographic data, surgical history, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were recorded. Endothelial cell parameters were assessed using non-contact specular microscopy, and corneal morphology was evaluated with Scheimpflug-based tomography, including pachymetric distribution, posterior corneal elevation, and higher-order aberrations. RESULTS: Forty-five eyes of 39 patients (mean age 69.8 ± 10.5 years; 86% female) were analyzed. Phacoemulsification was the most common prior procedure (91.1%), and the mean interval between surgery and FECD diagnosis was 33.4 ± 24.1 months. Mean BCVA showed a numerical but statistically non-significant increase from 0.18 ± 0.07 at presentation/FECD diagnosis to 0.36 ± 0.19 at the last follow-up visit (p = 0.090). Mean IOP was 16.0 ± 4.3 mmHg at presentation/FECD diagnosis and 14.8 ± 4.4 mmHg at the last follow-up visit, with no statistically significant change (p = 0.087). Specular microscopy demonstrated reduced endothelial cell density (1146.7 ± 467.7 cells/mm2), increased polymegathism (CV: 33.8 ± 14.9%), and decreased hexagonality (17.5 ± 29.9%). Mean central corneal thickness was 588.0 ± 83.6 µm by specular microscopy and 636.0 ± 105.5 µm by tomography. Tomography revealed loss of regular isopach contours (90%), posterior corneal elevation (66.7%), and thinnest point displacement (46.7%). Posterior corneal higher-order aberrations were increased (3.93 ± 4.01 µm RMS). Endothelial keratoplasty was indicated in 38 eyes (84.4%). CONCLUSIONS: Previously unrecognized FECD may predispose patients to postoperative corneal decompensation after intraocular surgery, and comprehensive endothelial and tomographic assessment may facilitate earlier diagnosis, improved risk stratification, and reduced postoperative corneal morbidity.