{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:13:59Z","timestamp":1783674839422,"version":"3.55.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FIS PI22\/01252"],"award-info":[{"award-number":["FIS PI22\/01252"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100031478","name":"NextGenerationEU","doi-asserted-by":"publisher","award":["Programa Investigo, Plan de Recuperaci\u00f3n, Transformaci\u00f3n y Resiliencia (NextGenerationEU)."],"award-info":[{"award-number":["Programa Investigo, Plan de Recuperaci\u00f3n, Transformaci\u00f3n y Resiliencia (NextGenerationEU)."]}],"id":[{"id":"10.13039\/100031478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eye and Vis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Accurate preoperative identification of patients with Fuchs endothelial corneal dystrophy (FECD) who are at risk of requiring endothelial keratoplasty (EK) after cataract surgery remains challenging. The SUbClinical Corneal Edema Scheimpflug Study (SUCCESS) score was previously developed to estimate this risk using Scheimpflug tomography. We aimed to prospectively and externally validate the SUCCESS score in an independent multicenter cohort and determine whether the incorporation of corneal densitometry improves predictive performance and clinical utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective multicenter cohort study, 207 eyes from 177 patients with FECD grade\u2009\u2265\u20092 and visually significant cataract were enrolled across six tertiary hospitals in Spain (June 2020 to October 2024), with follow-up through May 2025. After predefined exclusions, 178 eyes (149 patients) were analyzed. The original SUCCESS score was used without recalibration. An extended model incorporated peak mean corneal densitometry within the central 3-mm zone. Time-to-event analyses were performed using Cox proportional hazards models. Discrimination, calibration, reclassification, and clinical utility were assessed using Harrell\u2019s C-index, Brier score, net reclassification index (NRI), integrated discrimination improvement (IDI), and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Over a median follow-up of 37.0\u00a0months (interquartile range [IQR], 10.1\u201345.9), 38 eyes (21%) met the criteria for EK, with 82% of events occurring within 6\u00a0months after phacoemulsification. The original SUCCESS score demonstrated good discrimination (C-index\u2009=\u20090.80; 95% confidence interval [CI], 0.73\u20130.86) with slight underestimation of absolute risk (predicted 16.4% vs. observed 21.6%). Incorporation of corneal densitometry improved discrimination (C-index\u2009=\u20090.85; 95% CI, 0.79\u20130.90; \u0394C\u2009=\u2009+\u20090.05;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.0047), reduced prediction error (\u0394Brier\u2009= \u2212\u20090.019;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), and enhanced risk reclassification (NRI\u2009=\u20090.39; 95% CI, 0.14\u20130.64;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002), including correct upward reclassification of 26% of eyes requiring EK. The extended model provided greater net benefit at relevant decision thresholds (25%\u201350%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this multicenter external validation study, the SUCCESS score demonstrated a robust performance in predicting postoperative EK in FECD. The addition of corneal densitometry provided incremental improvements in discrimination and clinically meaningful risk stratification, particularly in intermediate-risk cases. Standardized Scheimpflug-based risk assessment may support individualized surgical planning and referral decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40662-026-00501-4","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T08:18:30Z","timestamp":1783671510000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation and extension of the SUCCESS score for Fuchs dystrophy after cataract surgery"],"prefix":"10.1186","volume":"13","author":[{"given":"Francisco","family":"Arnalich-Montiel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Stokking","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerea","family":"Saenz-Madrazo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Etxebarria-Ecenarro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Arriola-Villalobos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Gessa-Sorroche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Mart\u00edn-Ucero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Muriel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anabel","family":"Blasco-Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"V\u00e1zquez-Fari\u00f1as","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ver\u00f3nica","family":"Gomez-Calleja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco J.","family":"Mu\u00f1oz-Negrete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Mingo-Bot\u00edn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"issue":"7","key":"501_CR1","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1097\/j.jcrs.0000000000000207","volume":"46","author":"A Viberg","year":"2020","unstructured":"Viberg A, Samolov B, Claesson Armitage M, Behndig A, Bystr\u00f6m B. Incidence of corneal transplantation after phacoemulsification in patients with corneal guttata: a registry-based cohort study. J Cataract Refract Surg. 2020;46(7):961\u20136.","journal-title":"J Cataract Refract Surg"},{"issue":"2","key":"501_CR2","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.ophtha.2018.07.005","volume":"126","author":"SY Sun","year":"2019","unstructured":"Sun SY, Wacker K, Baratz KH, Patel SV. Determining subclinical edema in Fuchs endothelial corneal dystrophy: revised classification using Scheimpflug tomography for preoperative assessment. Ophthalmology. 2019;126(2):195\u2013204.","journal-title":"Ophthalmology"},{"key":"501_CR3","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.ajo.2021.04.016","volume":"231","author":"F Arnalich-Montiel","year":"2021","unstructured":"Arnalich-Montiel F, de-Arriba-Palomero P, Muriel A, Mingo-Bot\u00edn D. A risk prediction model for endothelial keratoplasty after uncomplicated cataract surgery in Fuchs endothelial corneal dystrophy. Am J Ophthalmol. 2021;231:70\u20138.","journal-title":"Am J Ophthalmol"},{"key":"501_CR4","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.ajo.2019.07.012","volume":"208","author":"F Arnalich-Montiel","year":"2019","unstructured":"Arnalich-Montiel F, Mingo-Bot\u00edn D, De Arriba-Palomero P. Preoperative risk assessment for progression to descemet membrane endothelial keratoplasty following cataract surgery in Fuchs endothelial corneal dystrophy. Am J Ophthalmol. 2019;208:76\u201386.","journal-title":"Am J Ophthalmol"},{"issue":"2","key":"501_CR5","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.ophtha.2013.09.047","volume":"121","author":"H Van Cleynenbreugel","year":"2014","unstructured":"Van Cleynenbreugel H, Remeijer L, Hillenaar T. Cataract surgery in patients with Fuchs\u2019 endothelial corneal dystrophy: when to consider a triple procedure. Ophthalmology. 2014;121(2):445\u201353.","journal-title":"Ophthalmology"},{"issue":"4","key":"501_CR6","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1001\/archopthalmol.2011.1626","volume":"130","author":"LJ Kopplin","year":"2012","unstructured":"Kopplin LJ, Przepyszny K, Schmotzer B, Rudo K, Babineau DC, Patel SV, et al. Relationship of Fuchs endothelial corneal dystrophy severity to central corneal thickness. Arch Ophthalmol. 2012;130(4):433\u20139.","journal-title":"Arch Ophthalmol"},{"key":"501_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12916-014-0241-z","volume":"13","author":"GS Collins","year":"2015","unstructured":"Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): The TRIPOD Statement. BMC Med. 2015;13:1.","journal-title":"BMC Med"},{"issue":"4","key":"501_CR8","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1159\/000456720","volume":"57","author":"RI Barraquer","year":"2017","unstructured":"Barraquer RI, Pinilla Cort\u00e9s L, Allende MJ, Montenegro GA, Ivankovic B, D\u2019Antin JC, et al. Validation of the Nuclear Cataract Grading System BCN 10. Ophthalmic Res. 2017;57(4):247\u201351.","journal-title":"Ophthalmic Res"},{"issue":"12","key":"501_CR9","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1001\/archopht.1995.01100120038005","volume":"113","author":"SD Cassard","year":"1995","unstructured":"Cassard SD, Patrick DL, Damiano AM, Legro MW, Tielsch JM, Diener-West M, et al. Reproducibility and responsiveness of the VF-14: an index of functional impairment in patients with cataracts. Arch Ophthalmol. 1995;113(12):1508\u201313.","journal-title":"Arch Ophthalmol"},{"issue":"1","key":"501_CR10","doi-asserted-by":"publisher","DOI":"10.1186\/s12886-025-04200-x","volume":"25","author":"C Elhardt","year":"2025","unstructured":"Elhardt C, Aamoon AZ, Hartmann LM, Gr\u00fcn CMS, Wolf A, Wertheimer CM. Reduced quality of life in corneal dystrophy \u2013 a prospective case control study. BMC Ophthalmol. 2025;25(1):341.","journal-title":"BMC Ophthalmol"},{"issue":"6","key":"501_CR11","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1097\/ICO.0000000000002762","volume":"41","author":"K Shah","year":"2022","unstructured":"Shah K, Eghrari AO, Vanner EA, O\u2019Brien TP, Koo EH. Scheimpflug corneal densitometry values and severity of guttae in relation to visual acuity in Fuchs endothelial corneal dystrophy. Cornea. 2022;41(6):692\u20138.","journal-title":"Cornea"},{"issue":"1","key":"501_CR12","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1167\/iovs.06-0767","volume":"48","author":"SV Patel","year":"2007","unstructured":"Patel SV, Winter EJ, McLaren JW, Bourne WM. Objective measurement of backscattered light from the anterior and posterior cornea in vivo. Invest Ophthalmol Vis Sci. 2007;48(1):166\u201372.","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"3","key":"501_CR13","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.ophtha.2019.09.033","volume":"127","author":"SV Patel","year":"2020","unstructured":"Patel SV, Hodge DO, Treichel EJ, Spiegel MR, Baratz KH. Predicting the prognosis of Fuchs endothelial corneal dystrophy by using Scheimpflug tomography. Ophthalmology. 2020;127(3):315\u201323.","journal-title":"Ophthalmology"},{"issue":"6","key":"501_CR14","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.65.6.15","volume":"65","author":"C Kai","year":"2024","unstructured":"Kai C, Oie Y, Nishida N, Doi S, Fujimoto C, Asonuma S, et al. Associations between visual functions and severity gradings, corneal scatter, or higher-order aberrations in Fuchs endothelial corneal dystrophy. Invest Ophthalmol Vis Sci. 2024;65(6):15.","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"5","key":"501_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.xops.2025.100830","volume":"5","author":"SSJ Poh","year":"2025","unstructured":"Poh SSJ, Tey KY, Peh GSL, Neo DJH, Htoon HM, Lee EKL, et al. Assessment of early Fuchs endothelial corneal dystrophy and CTG trinucleotide expansion positivity using Scheimpflug imaging. Ophthalmol Sci. 2025;5(5):100830.","journal-title":"Ophthalmol Sci"},{"issue":"3","key":"501_CR16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0298795","volume":"19","author":"JM Perone","year":"2024","unstructured":"Perone JM, Luc MS, Zevering Y, Vermion JC, Gan G, Goetz C. Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: tips for improving cataract surgery research. PLoS One. 2024;19(3):e0298795.","journal-title":"PLoS ONE"},{"issue":"4","key":"501_CR17","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1016\/S0886-3350(03)00648-5","volume":"30","author":"PD O\u2019Brien","year":"2004","unstructured":"O\u2019Brien PD, Fitzpatrick P, Kilmartin DJ, Beatty S. Risk factors for endothelial cell loss after phacoemulsification surgery by a junior resident. J Cataract Refract Surg. 2004;30(4):839\u201343.","journal-title":"J Cataract Refract Surg"}],"container-title":["Eye and Vision"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40662-026-00501-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40662-026-00501-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40662-026-00501-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T08:18:31Z","timestamp":1783671511000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40662-026-00501-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["501"],"URL":"https:\/\/doi.org\/10.1186\/s40662-026-00501-4","relation":{},"ISSN":["2326-0254"],"issn-type":[{"value":"2326-0254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]},"assertion":[{"value":"8 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee for Research with Medicines of Hospital Universitario Ram\u00f3n y Cajal, Madrid, Spain (CEIm Hospital Universitario Ram\u00f3n y Cajal; study reference 062\/20). The approved study was entitled \u201cEscala de riesgo de descompensaci\u00f3n corneal en cirug\u00eda de catarata en pacientes con distrofia corneal de Fuchs\u201d. A substantial amendment, including Protocol and Patient Information Sheet\/Informed Consent Form version 4.0 dated 19 April 2023, was approved by the same committee on 18 April 2023 (Acta No. 452). Written informed consent was obtained from all participants before inclusion. The study was conducted in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"30"}}