Risk factors for corneal transplantation in Fuchs endothelial corneal dystrophy from a large Thai cohort

This study aimed to identify risk factors associated with corneal transplantation within five years among Thai patients with Fuchs endothelial corneal dystrophy (FECD) and to evaluate whether isolated cataract surgery could defer the need for corneal transplantation. We retrospectively reviewed 900 patients (1,743 eyes) at King Chulalongkorn Memorial Hospital between January 2017 and June 2023. Associations were assessed using logistic regression. Significant predictors of transplantation included advanced disease stage (Adamis' grade ≥ 2; odds ratio [OR] = 6.40), reduced endothelial cell density (ECD ≤ 1600 cells/mm²; OR = 5.30), increased central corneal thickness (CCT ≥ 590 μm; OR = 2.64), and worse baseline best-corrected visual acuity (BCVA ≥ 0.3 logMAR; OR = 2.02). Among 274 phakic eyes undergoing isolated cataract surgery, preoperative ECD ≤ 1700 cells/mm² or CCT ≥ 550 μm were associated with postoperative progression. These thresholds should be regarded as exploratory, particularly in the cataract subgroup where event numbers were small and follow-up was short. Nevertheless, our findings may help improve risk stratification, guide preoperative counseling, and support efficient donor allocation in regions facing chronic shortages.