Journal article
Delphi-Based Global Consensus on Fuchs Endothelial Corneal Dystrophy. An Endothelial Keratoplasty Learners Group Initiative
American journal of ophthalmology, Vol.280, pp.130-143
12/2025
DOI: 10.1016/j.ajo.2025.08.012
PMID: 40789362
Abstract
To identify areas of consensus among global experts for the management of Fuchs endothelial corneal dystrophy (FECD) in clinical practice, including its diagnosis, evaluation, decision-making principles with respect to intervention, and recommendations for performing cataract surgery in patients with FECD, including when to combine with keratoplasty.
Modified Delphi-based global consensus.
Thirty-seven ophthalmologists from around the world with significant expertise in the management and mechanisms of FECD. Methods: A series of consensus statements about FECD were developed from three iterative rounds of structured questions and statements posed to the panel of experts. Two rounds were asynchronous electronic questionnaires, and the third round was a live virtual meeting. Experts responded anonymously to statements assessing consensus and to open-ended questions that invited diverse input. Main Outcome Measures: Consensus was defined as ³70% agreement among experts.
Consensus was reached for 90 of 91 statements after three rounds. Experts agreed that FECD is defined by the presence of central or paracentral scattered or confluent guttae with or without edema. There was strong consensus that a chronic state of subclinical edema precedes the onset of clinically detectable edema that may or may not cause symptoms. With near-unanimous consensus, disease evaluation recommendations included assessing for findings that implicate the cornea as a source of decreased vision to separate it from the effect of comorbid conditions, as this would inform whether corneal intervention is appropriate. These findings include diurnal variation in vision, clinical or subclinical (tomographic) edema, and changes or differences in central corneal thickness. Based on current evidence, experts agreed that there are no effective medical therapies for FECD, and that Descemet membrane endothelial keratoplasty is the surgical treatment of choice when indicated.
The consensus statements provide current globally endorsed recommendations for the diagnosis and management of FECD. The guidelines are important and relevant for general ophthalmologists, who typically first diagnose and evaluate FECD, and for cornea specialists, by allowing them to benchmark their current practice patterns against expert recommendations. This could help improve patient outcomes and establish a framework adaptable to future advances and evolving technologies in the management of FECD.
Details
- Title: Subtitle
- Delphi-Based Global Consensus on Fuchs Endothelial Corneal Dystrophy. An Endothelial Keratoplasty Learners Group Initiative
- Creators
- Sanjay V. Patel - Mayo Clinic in ArizonaNidhi Gupta - Singapore Eye Research InstituteManinder Bhogal - St Thomas' HospitalUla V. Jurkunas - Massachusetts Eye and Ear InfirmaryNaoki Okumura - Doshisha UniversityVito Romano - University of BresciaBruce D. Allan - University College LondonKeith H. Baratz - Mayo Clinic in ArizonaSamar K. Basak - Disha Eye Hospitals, Kolkata, IndiaLamis Baydoun - ELZA InstituteWinston Chamberlain - Oregon Health & Science UniversitySunita Chaurasia - L V Prasad Eye InstituteKathryn Colby - New York UniversityClaus Cursiefen - University of CologneTiciano Giobellina - Reyes-Giobellina Eye Clinic, Córdoba, ArgentinaMark A. Greiner - University of IowaJesper Hjortdal - Aarhus University HospitalAkira Kobayashi - Kanazawa University HospitalViridiana Kocaba - Singapore Eye Research InstituteEllen H. Koo - University of MiamiW. Barry Lee - Minnesota Eye ConsultantsEitan Livny - Rabin Medical CenterJohn J. Males - The University of SydneyMario Matthaei - University of CologneJodhbir S. Mehta - Singapore National Eye CenterLuis Mejia - Clínica CESGregory Moloney - University of British ColumbiaV. Vinod Mootha - The University of Texas Southwestern Medical CenterMarc Muraine - Université de Rouen NormandieYoshinori Oie - The University of OsakaNicolas Cesário Pereira - Universidade de SorocabaFrancis W. Price - Price Vision GroupDivya Srikumaran - Johns Hopkins UniversityMark A. Terry - Legacy HealthPeter B. Veldman - University of ChicagoDavid D. Verdier - Verdier Eye Center, Grand Rapids, MI, USAPravin K. Vaddavalli - L V Prasad Eye InstituteRoberto Pineda - Massachusetts Eye and Ear Infirmary
- Resource Type
- Journal article
- Publication Details
- American journal of ophthalmology, Vol.280, pp.130-143
- DOI
- 10.1016/j.ajo.2025.08.012
- PMID
- 40789362
- NLM abbreviation
- Am J Ophthalmol
- ISSN
- 0002-9394
- eISSN
- 1879-1891
- Publisher
- Elsevier Inc
- Language
- English
- Electronic publication date
- 08/09/2025
- Date published
- 12/2025
- Academic Unit
- Pharmaceutical Sciences and Experimental Therapeutics; Ophthalmology and Visual Sciences
- Record Identifier
- 9984946841102771
Metrics
9 Record Views