Clinical features of cornea guttata in patients with age-related cataract

Objective  To investigate the prevalence and risk factors of cornea guttata in patients with age-related cataract.

Methods  A cross-sectional study was conducted.A total of 1 472 patients aged 50-89 years with complete medical records, who were diagnosed with age-related cataract and to undergo surgery, were enrolled at Peking University People’s Hospital from August 2018 to July 2019.The presence of guttata was determined according to the specular microscopy images and the overall prevalence of guttata was calculated, as well as the prevalence rates of different gender, eye, and age distribution.Patients were divided into a guttata group (96 cases 130 eyes) and a non-guttata group (1 376 cases 2 814 eyes), and the differences in general information between groups were compared.The corneal endothelial cell density (CD), coefficient of variation of cell size (CV), fraction of hexagonal cells (6A), axial length (AL), white to white (WTW), anterior chamber depth, and corneal vertex thickness were compared between the two groups, and only the right eye of the patient with both eyes affected was included for analysis.The risk factors of guttata were analyzed by multivariate logistic regression.Differences in influencing factors among different guttata grades were compared, and the differences in biometric parameters of each eye in both eyes of guttata patients were compared.This study adhered to the Declaration of Helsinki, and the study protocol was approved by the Ethics Committee of Peking University People’s Hospital (No.2023PHB198-001).

Results  Of the 1 472 patients, 96(6.52%) patients had cornea guttata.The prevalence rate of guttata in males was 4.04%, which was significantly lower than 8.20% in females ( χ ²=10.058, P=0.002).The average age of patients in the guttata group was (71.19±8.57) years old, with 24 males and 72 females, including 62 patients with monocular guttata and 39 patients with isolated guttata.Multivariate logistic regression analysis showed that female (odds ratio [ OR]=2.124, 95% confidence interval [ CI]: 1.306-3.455), greater AL ( OR=1.201, 95% CI: 1.083-1.332), shallow anterior chamber depth ( OR=0.439, 95% CI: 0.252-0.766), and greater corneal vertex thickness ( OR=1.008, 95% CI: 1.001-1.015) were risk factors for guttata.There were statistically significant differences in the proportion of monocular guttata and biocular guttata among different grades groups, and between isolated guttata and non-isolated guttata ( χ ²=25.492, 15.362; both P<0.05).Differences in CD and corneal vertex thickness among different grades groups were statistically significant ( F=3.264, 5.784; both P<0.05).The CD was significanty higher and the corneal vertex thickness was significantly thinner in the grade 1 than in the grade ≥3 (both P<0.017).There was no statistically significant difference in binocular CD, CV, 6A, AL, WTW, anterior chamber depth, and corneal vertex thickness between both eyes of monocular or binocular guttata patients (all P>0.05).

Conclusions  The risk factors of guttata include female, long AL, shallow anterior chamber depth, and thick corneal vertex thickness.The guttata grade of monocular guttata and isolated guttata patients is lower.With the increase of grade, the corneal vertex thickness increases.There is no difference in ocular structure between both eyes of guttata patients.

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