Fuchs endothelial corneal dystrophy and small eyes

  • Nicole Shao-Yuen Lim Sydney Eye Hospital
  • John Males
Keywords: anterior chamber depth, axial length, Fuchs endothelial corneal dystrophy, hypermetropia, hyperopia


Aim: To determine whether there is an association between Fuchs endothelial corneal dystrophy (FECD) and shorter axial length (AL), shallower anterior chamber depth (ACD) and higher spherical equivalent (SE). In addition, to evaluate whether there is a correlation between AL and severity of corneal decompensation in FECD, using corneal thickness as a proxy.

Design: Retrospective cohort study.

Methods: This was a single-centre study conducted in a cornea clinic in Sydney, Australia. Detailed clinical measurements of 91 eyes of 50 FECD patients were compared with 110 eyes of 55 controls. Main outcome measures included AL, ACD and SE. Other outcome measures included central corneal thickness, visual acuity, intraocular pressure and keratometry.

Results: Mean AL of FECD patients was 23.6 mm (standard deviation [SD] ±0.9 mm), compared with 24.7 mm (SD ±1.8 mm) for controls (1.1 mm difference [95% confidence interval [CI] 0.5-1.6], p < 0.001, independent sample t-test); corresponding means for ACD were 3.0 and 3.3 mm (0.32 mm difference [95%CI 0.2-0.5], p < 0.001, independent t-test). Eleven out of the 22 FECD patients with available refraction data had hypermetropic refraction compared with 16 out of 36 controls (p = 0.68, chi-squared test). The mean SE of FECD patients (+0.10D) was higher than controls (−1.33D) (1.4D difference [0.1-2.8], p = 0.04, independent t-test). No statistically significant correlation was found between AL and corneal thickness (p = 0.28, linear regression).

Conclusion: In this retrospective cohort study, a strong association was established between FECD and small eyes, with shorter AL and shallower ACD, compared with controls. These results have important implications for surgical planning, as shorter AL and ACD in FECD patients likely contribute to their high risk of corneal decompensation following cataract surgery.

Author Biography

John Males

Dr John Males, Principal surgeon at Sydney Cornea Clinic, is a leader in laser vision correction, cataract surgery, corneal transplantation including DSEK, DSAEK and DALK, keratoconus treatments including collagen cross linking, corneal rings (Kerarings and Intacs), phakic intraocular lenses, and anterior segment reconstruction.

John is a consultant ophthalmologist at Sydney Eye Hospital, St Vincent's Public and St Vincent's Private Hospitals, Concord Hospital and Macquarie University Hospital. He is a Clinical Senior Lecturer at both the University of Sydney, Macquarie University and is the head of the Corneal Unit at Sydney Eye Hospital. John is the Head of the Department of Ophthalmology at St Vincent's Public Hospital. He is a Co-ordinator for the Masters of Refractive Surgery at the University Sydney, the first post graduate degree in refractive surgery in the world.

Dr Males underwent his medical training at the University of Sydney and his Ophthalmic training in Sydney Eye Hospital, and Bristol Eye Hospital in the United Kingdom.

Dr Males has been at the forefront of ophthalmology and has introduced numerous surgical techniques in Australia. His achievements include:

  • The first in Australia to perform DSAEK endothelial corneal transplantation;
  • The first in Australia to perform collagen cross linking (C3R, UVX) for the stabilisation of keratoconus;
  • The first in Australia to perform custom iris implant surgery with the Human Optics iris prosthesis;
  • Amongst the first surgeons to perform laser assisted cataract surgery in Australia; and
  • Amongst the leading group of surgeons performing SMILE laser vision correction in Australia.


Park CY, Lee JK, Gore PK, Lim CY, Chuck RS. Keratoplasty in the United States: a 10-year review from 2005 through 2014. Ophthalmology. 2015;122(12):2432-2442. doi: 10.1016/j.ophtha.2015.08.017.

De Sanctis U, Alovisi C, Bauchiero L, et al. Changing trends in corneal graft surgery: a ten-year review. Int J Ophthalmol. 2016;9(1):48-52. doi: 10.18240/ijo.2016.01.08.

Elhalis H, Azizi B, Jurkunas UV. Fuchs endothelial corneal dystrophy. Ocul Surf. 2010;8(4):173-184.

Pitts JF, Jay JL. The association of Fuch’s corneal endothelial dystrophy with axial hypermetropia, shallow anterior chamber, and angle closure glaucoma. Br J Ophthalmol. 1990;74:601-604.

Lowenstein A, Geyer O, Hourvitz D, Lazar M. The association of Fuchs corneal endothelial dystrophy with angle closure glaucoma. [Letter to Ed] Br J Ophthalmol. 1991;75(8):510.

Shen P, Zheng Y, Ding X, et al. Biometric measurements in highly myopic eyes. J Cataract Refract Surg. 2013;39(2):180-187. doi: 10.1016/j.jcrs.2012.08.064.

Sahin A, Hamrah P. Clinically relevant biometry. Curr Opin Ophthalmol. 2012;23(1):47-53. doi: 10.1097/ICU.0b013e32834cd63e.

Nakhli FR. Comparison of optical biometry and applanation ultrasound measurements of the axial length of the eye. Saudi J Ophthalmol. 2014;28(4):287-291. doi: 10.1016/j.sjopt.2014.04.003.

Hwang HB, Lyu B, Yim HB, Lee NY. Endothelial cell loss after phacoemulsification according to different anterior chamber depths. J Ophthalmol. 2015;2015:21076. doi: 10.1155/2015/210716.

Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg. 2000;26(5):727-732.

Samarawickrama C, Wang JJ, Burlutsky G, Tan AG, Mitchell P. Nuclear cataract and myopic shift in refraction. Am J Ophthalmol. 2007;144(3):457-459.

De Bernardo M, Zeppa L, Forte R, et al. Can we use the fellow eye biometric data to predict IOL power? Semin in Ophthalmol. 2017;32(3):363-370. doi: 10.3109/08820538.2015.1096400.

Covert DJ, Henry CR, Koenig SB. Intraocular lens power selection in the second eye of patients undergoing bilateral, sequential cataract extraction. Ophthalmology. 2010;117:49-54. doi: 10.1016/j.ophtha.2009.06.020.

Rose K, Smith W, Morgan I, Mitchell P. The increasing prevalence of myopia: implications for Australia. Clin Exp Ophthalmol. 2001;29(3):116-120.

Pan CW, Boey PY, Cheng CY, et al. Myopia, axial length, and age-related cataract: the Singapore Malay eye study. Invest Ophthalmol Vis Sci. 2013;54(7):4498-4502. doi: 10.1167/iovs.13-12271.

Armstrong RA. Statistical guidelines for the analysis of data obtained from one or both eyes. Ophthalmic Physiol Opt. 2013;33(1):7-14. doi: 10.1111/opo.12009.

How to Cite
Lim, N., & Males, J. (2020). Fuchs endothelial corneal dystrophy and small eyes. Asian Journal of Ophthalmology, 17(1), 35-40. https://doi.org/10.35119/asjoo.v17i1.445