Fuchs endothelial corneal dystrophy (FECD) is a progressive, age-related disorder characterised by premature endothelial cell loss and the development of guttae on the posterior corneal surface. It predominantly affects adults over 40 years of age, with a female predominance, and evolves slowly over several decades. Although its pathophysiology remains incompletely understood, a strong genetic association with CTG trinucleotide repeat expansion in the TCF4 gene has been demonstrated in Caucasian populations 1. In parallel, oxidative stress—particularly that induced by ultraviolet (UV) radiation—has been implicated in experimental models of endothelial injury 2-4. Given these data, we conducted a prevalence study of FECD in a dermatology outpatient population characterised by a high burden of sun-exposure–related diseases. The aim was to estimate FECD prevalence in this specific setting and to explore associations with cutaneous malignancies, particularly basal cell carcinoma (BCC). This single-centre study was performed between February and July 2024 at Saint-Étienne University Hospital. Adult patients (> 18 years) attending the dermatology department were randomly selected. FECD screening was carried out using non-contact specular microscopy (Topcon SP-3000P) after brief training of dermatologists, with image interpretation performed by two corneal specialists. FECD was defined using a broad criterion: the presence of at least one gutta. Collected variables included age, sex, history of cataract surgery and associated dermatological diagnoses. Ethics approval for this study was obtained from the ‘Terre d'Ethique’ Ethics Committee of the University Hospital of Saint-Étienne. Written informed consent was obtained from each patient. A total of 1235 patients were initially included. After data cleaning and predefined exclusions, 1191 patients were analysable (28 measurement failures due to insufficient image quality, 6 cases with data collection errors, and 10 empty records removed during database verification). The mean age was 58 ± 17 years, with an even sex distribution. Image quality was sufficient in 97% of cases. Multiple images per eye were obtained when necessary; however, the quality metric refers to the first acquisition, supporting the feasibility of rapid screening. Ninety-three patients were diagnosed with FECD, corresponding to a prevalence of 7.8% (93/1191) (Figure 1). Patients with FECD were significantly older than unaffected subjects (68 ± 10 vs. 57 ± 17 years, p = 0.001) and more often female (61.3% vs. 49.6%, p = 0.04). Most cases were early stage (Laing grades 1–3). Endothelial cell density was significantly lower in FECD patients than in controls. Among patients with FECD, 27 had basal cell carcinoma, 9 melanoma and 9 squamous cell carcinoma (Table 1). Analysis of dermatologic comorbidities revealed a strong association between FECD and basal cell carcinoma. BCC was present in 29.0% of FECD patients versus 13.2% of non-FECD patients (p < 0.001). In multivariate analysis, BCC remained independently associated with FECD (odds ratio 1.81, p = 0.025) (Figure 2). These findings are consistent with previous reports of increased cancer risk in patients with FECD 5. Although squamous cell carcinoma showed a higher prevalence in FECD patients on univariate analysis, this association did not persist after adjustment. No significant relationship was observed with melanoma or psoriasis. Our recruitment strategy intentionally introduced a selection bias by screening in a dermatology referral centre; however, this design allowed us to study a population with increased UV exposure. Experimental data support the hypothesis that UV-induced oxidative stress may contribute to endothelial dysfunction. UVA irradiation in murine models reproduces key FECD features, including premature endothelial cell loss and greater susceptibility in females 3, 4. These mechanisms provide biological plausibility for a shared vulnerability between FECD and BCC. Strengths of this study include the large sample size, standardised non-invasive screening and demonstration of feasibility outside an ophthalmology department. Limitations include the absence of complete ophthalmic examination or genetic confirmation, reliance on central endothelial imaging and limited generalisability to the overall French population. In patients with basal cell carcinoma, our findings demonstrate a significantly increased prevalence of FECD compared with patients without BCC. This suggests that individuals with BCC may represent a subgroup with heightened susceptibility to UV-related oxidative damage affecting both the skin and corneal endothelium. In this specific population, targeted ophthalmologic screening using non-contact specular microscopy may be justified to detect FECD at an early, often asymptomatic stage and to better anticipate corneal risk, particularly before intraocular surgery. Therefore, dermatologic evaluation or skin cancer screening could also be considered in these patients. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Piteau et al. (2026) studied this question.