​​Baseline BCVA Correlates with Surgical Outcomes for Corneal Opacities

Endothelial keratoplasty was the most commonly performed procedure in this retrospective study. Photo: Francis Price, Jr., MD. Click image to enlarge. Loss of corneal clarity accounts for the fourth leading cause of blindness globally. Due to this prevalence, researchers wanted to better elucidate the outcomes of various surgeries for corneal opacity.A new retrospective study appearing in Cornea included data from the Intelligent Research Insight (IRIS) Registry. In total, 44,073 patients underwent surgery for corneal opacity; mean age was 67.2 and 55% were women. Leading causes for surgery, in order, were corneal dystrophy (39%), corneal edema (21%), noninfectious ulcers (6.4%), infectious keratitis (6.1%) and trauma (1.7%), with another 15% possessing multiple etiologies. The most common procedures were endothelial keratoplasty (62.8%), penetrating keratoplasty (31.3%) and lamellar keratoplasty (2.1%). A few cases also included ocular surface reconstruction. After analysis, it was found that best-corrected visual acuity (BCVA) improved significantly after surgery; however, a poorer baseline BCVA was linked with worse outcomes.A discussion of these results in the paper touches on the current state of surgical options for corneal opacities, with the study authors highlighting that, often, corneal transplantation often remains as the only therapeutic approach. The current study indicated that from all patients with a corneal opacity, only 0.8% underwent surgical intervention, possibly because of lack of universal surgical care access. Despite this low rate, corneal transplantation procedures performed in the US have risen slightly from 2013 to 2023, reflecting moderate growth in surgical interventions to address corneal opacities and their underlying etiologies.Endothelial dystrophy belonged to the most common etiology for surgery (corneal dystrophies), and as such, the most performed procedure in this cohort was endothelial keratoplasty, then penetrating and lamellar keratoplasty. Those who underwent endothelial keratoplasty in particular were found to have significantly improved BCVA. Conversely, those who had penetrating keratoplasty had poorer vision at diagnosis—indicative of more severe disease—thus prompting the more intense surgery, which is the choice for patients with edema, severe ulcers and infectious keratitis.Fortunately, the increased availability of highly effective antimicrobial therapies has reduced a large need for therapeutic keratoplasty in corneal opacities caused by infectious keratitis. In total, only 2,829 patients underwent surgery in this cohort due to infectious etiologies.The authors emphasize their finding of baseline BCVA being a strong predictor of post-op outcomes, as presenting with more severe visual impairment resulted in less likely favorable vision at one year post-procedure. They relay that “this finding highlights the need for earlier identification and referral of patients with corneal opacity to optimize visual rehabilitation.”Click here for the journal source. Singh RB, Dohlman TH, Ivanov A, et al.; IRIS Registry Analytic Center Consortium. Surgical outcomes in patients diagnosed with corneal opacity: an IRIS (Intelligent Research in Sight) Registry study. Cornea. August 15, 2025. [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.