Correlation Between Endothelial Morphology, Ocular Biometric Parameters, and Systemic Comorbidities in a Large Caucasian Cohort.

Background/Objectives: To evaluate the association between demographic, ocular biometric, and systemic comorbidity variables with corneal endothelial morphometric parameters in a Caucasian adult population undergoing cataract surgery. Methods: Cross-sectional study in a large cohort of patients who were candidates for cataract surgery with no other concomitant ocular pathology. Endothelial cell density (ECD), hexagonality (HEX), the coefficient of variation (CV), and the presence of guttae were assessed using specular microscopy (Tomey EM-4000). Biometric parameters were obtained by partial coherence interferometry (IOLMaster 700), and systemic comorbidities were recorded. Multiple linear regression models adjusted for age and sex were applied, along with stratified analyses according to axial length (AL). Results: A total of 1032 eyes from 1032 patients were included. The mean age was 75.9 ± 9.3 years. The cohort comprised 366 men (35.5%) and 666 women (64.5%). The mean ECD was 2113 ± 544 cells/mm2, HEX 42.7 ± 21.6%, and CV 43.2 ± 9.6%. The prevalence of guttae was 15.4% (159 eyes). ECD correlated negatively with age (r = -0.148; p < 0.001) and positively with central corneal thickness (r = 0.091; p = 0.004) and anterior chamber depth (r = 0.064; p = 0.030). In the multivariate model, age was independently associated with lower ECD (β = -8.40 cells/mm2/year; p < 0.001), whereas male sex was associated with higher ECD and lower CV. No significant associations were found with AL, keratometry, or systemic comorbidities. Stratified analysis by AL group showed consistent patterns with no relevant differences. Conclusions: Corneal endothelial morphometry in Caucasian adults is primarily associated with age, sex, central corneal thickness, and anterior chamber depth, with no significant association with axial length or systemic comorbidities.