Preoperative BCVA Strongest Predictor of Surgical Outcomes in Patients with Corneal Opacity

For patients with corneal opacity, surgical intervention—especially endothelial keratoplasty—was found to result in meaningful BCVA improvements, though poorer baseline visual acuity was associated with worse vision outcomes at 12 months post-op. (Pictured: Reis-Bucklers corneal dystrophy). Photo: Christina Cherny, OD, and Suzanne Sherman, OD. Click image to enlarge. Researchers recently analyzed data from the Intelligent Research in Sight (IRIS) Registry to identify demographic and clinical variables that affect final vision outcomes in patients undergoing surgical intervention for corneal opacity. While surgery meaningfully improved vision in most patients, the report showed that those with poorer baseline visual acuity tended to have worse postoperative outcomes, underscoring the importance of treating before the disease becomes severe.The retrospective cohort study included 44,073 patients from the IRIS Registry who underwent surgery for corneal opacity between 2013 and 2020, accounting for just 0.84% of all diagnosed cases. The mean age was 67.24 years, and 55% were female. The most common underlying cause of corneal opacity in surgical patients was corneal dystrophy (39%), followed by corneal edema (21%), noninfectious ulcers (6.4%), infectious keratitis (6.1%) and trauma (1.7%). Multiple etiologies were present in 15% of patients. A variety of surgical approaches were used, endothelial keratoplasty being the most common (62.8%). From diagnosis to 12 months after surgery, mean BCVA improved significantly from 0.72 ±0.68 logMAR to 0.56 ±0.74 logMAR. By procedure, endothelial keratoplasty showed improvement from 0.57 ±0.56 to 0.41 ±0.57 logMAR, while penetrating keratoplasty improved from 0.87 ±0.69 to 0.70 ±0.82 logMAR. Patients undergoing ocular surface procedures (i.e., amniotic membrane transplantation, conjunctival autograft, limbal stem cell allograft and limbal conjunctival allograft) had more variable results, with smaller average gains.The strongest predictor of worse vision one year after surgery was poorer baseline BCVA, indicating more severe disease. “This finding,” the study authors wrote in their paper, “highlights the need for earlier identification and referral of patients with corneal opacity to optimize visual rehabilitation.”Importantly, the study also identified significant racial and ethnic disparities in visual outcomes. Postoperative BCVA was found to be worse among Black/African American, Asian and Hispanic patients compared with White and non-Hispanic patients, even after adjusting the analysis for clinical variables. The researchers noted in their paper, “These disparities may reflect broader systemic inequities in access to timely ophthalmic care and potential variations in surgical timing or follow-up adherence.” They added, “Our results underscore the need for targeted efforts to address disparities in ophthalmic care delivery, including outreach to underserved communities, standardization of surgical referral practices and culturally informed patient education.”Another important takeaway was the apparent influence of surgical modality on final vision outcomes, “with endothelial keratoplasty associated with better postoperative vision compared to penetrating keratoplasty or ocular surface reconstruction procedures.” The authors wrote, “This supports the growing clinical preference for endothelial surgical techniques in appropriate candidates, given their lower complication rates and superior visual rehabilitation.” Click here for the journal source. Singh RB, Dohlman TH, Ivanov A, et al. Surgical outcomes in patients diagnosed with corneal opacity: an IRIS (Intelligent Research in Sight) Registry study. Cornea. July 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.