Gender difference: Men less frequently but more severely affected in Fuchs endothelial corneal dystrophy (FECD)

Abstract

Abstract Purpose: Comparison of pre-operative findings and outcome of Descemet's membrane endothelial keratoplasty (DMEK) in female versus male patients with Fuchs endothelial corneal dystrophy (FECD).Methods: Records of consecutive DMEK surgeries performed between 2015 and 2019 at the Department of Ophthalmology at the University of Cologne and LMU Munich were retrospectively reviewed. Eyes with FECD with a complete 12 months follow-up were enrolled. Main outcome parameters included central corneal thickness (CCT), peripheral corneal thickness (PCT), best spectacle corrected visual acuity (BSCVA, log MAR), and endothelial cell count (ECC) before and after DMEK.Results: 144 eyes from 144 patients could be included in the study with FECD (female (f) n = 95, male (m) n = 49, ~ f:m:2:1). Preoperatively, CCT (f: 678.3 ± 128.8µm; m: 747.0 ± 148.0µm) and PCT (f: 702.6 ± 65.1µm; m: 782.4 ± 105.1µm) were both significantly higher in the male group (p < 0.01). Twelve months after DMEK, CCT (w: 541.0 ± 47.0µm; m 540.7 ± 37.5µm) showed no significant difference between the groups (p = 0.980), whereas the PCT showed a significant difference (f: 681.5 ± 66.3µm; m: 722.6 ± 71.7µm), p = 0.011. The increase in PCT correlated with accelerated ECC loss 12 months after DMEK (p = 0.009). Prior to DMEK, BSCVA in female FECD patients was higher, but without a significant difference (w: 0.38 ± 0.22logMAR; m 0.45 ± 0.34LogMAR, p = 0.256) compared to male patients with FECD. After 12 months, BSCVA improved in both groups without significant difference (p = 0.245).Conclusions: A large number of studies, including our present one, have consistently shown that women are more frequently affected by FECD. Our study suggests for the first time that men may be less frequently, but nevertheless more severely affected by FECD in terms of ECC loss and a higher CCT and PCT. Therefore, further gender-specific analyses should be performed in the disease of FECD.