Redistribution of Corneal Endothelial Cells After Descemet Stripping Only Combined With Cataract Surgery for Fuchs Endothelial Corneal Dystrophy
Tasha Miller, Stephan Ong TonePurpose:
Fuchs endothelial corneal dystrophy (FECD) is characterized by progressive corneal endothelial cell (CEC) loss and guttae formation. FECD pathology preferentially affects the central corneal endothelium (CE) before peripheral. Descemet stripping only (DSO) surgically removes diseased central CE and Descemet membrane, enabling rejuvenation through peripheral CEC migration. This study characterized central and peripheral CEC redistribution after DSO combined with cataract surgery.
Methods:
Retrospective analysis identified patients with FECD who underwent combined DSO and cataract surgery by a single surgeon between 2021 and 2025. Central and peripheral endothelial cell density (ECD), coefficient of variation, and percentage hexagonality were measured using specular microscopy (Konan CellChek 20 Plus) preoperatively and at 1 to 3, 3 to 6, 6 to 12, and ≥12 months postoperatively.
Results:
Sixteen eyes from 11 patients were included (mean age 71.2 ± 9.0 years; 81.8% female). Mean descemetorhexis diameter was 4.2 ± 0.3 mm (range 4–5 mm). Peripheral ECD declined significantly at 1 to 3 months postoperatively compared with preoperative values (1904.3 ± 524.3–987.3 ± 452.6 cells/mm
2
;
Conclusions:
After DSO combined with cataract surgery, early peripheral CEC depletion was accompanied by progressive central ECD recovery over 12 months, supporting peripheral redistribution as a primary mechanism of central CE rejuvenation.