Incidence of corneal transplantation after challenging cataract surgery in patients with and without corneal guttata

Abstract

Purpose: To study the risk for corneal transplantation after phacoemulsification with dense cataract or posterior capsule rupture (PCR) and the impact of corneal guttata. Setting: Forty-nine Swedish cataract surgical units and 8 Swedish cornea transplantation units. Design: Registry-based cohort study. Methods: Patient data from the Swedish National Cataract Registry (2010 to 2012) were linked with data from the Swedish Cornea Transplant Registry (2010 to 2017). The outcome measures were risk for future corneal transplantation, visual acuity, and self-assessed visual function after phacoemulsification. Logistic and Poisson regression analyses with adjustment for confounder effects were used to investigate the association of the outcome measures with dense cataract, indicated by trypan blue capsular staining (TB) and PCR, separately and together. Results: Altogether, data from 276 362 cataract patients were linked with data from 2091 patients with endothelial failure who underwent corneal transplantation.The risk for future corneal transplantation increased more than 3-fold with the presence of dense cataract or PCR, and a trend toward an ever-higher risk with the combination of TB and PCR together, but without any significant synergy of corneal guttata. Dense cataract, but not PCR, was significantly associated with an increased probability of inferior visual acuity after phacoemulsification. The impact on satisfaction was not statistically significant for any of the factors. Conclusions: Challenging cataract surgery increases the risk for future corneal transplantation equally in patients both with and without corneal guttata, despite a more vulnerable endothelium in the guttata group. This supports a strategy where PCR is limited and handled optimally and that cataract surgery is performed before the cataract turns critically dense.

Keratoplasty Registries: Lessons Learned

“…Overall, the incidence of keratoplasty after phacoemulsification is low (2.8/10,000 person-years). 79 However, the relative risk of corneal transplant after phacoemulsification was 68 times higher for patients with corneal guttata than those without corneal guttata. 78 Moreover, for patients with or without guttata, the relative risk of corneal transplant increased over 3-fold for dense cataracts requiring trypan blue staining or if posterior capsular rupture occurred.…”

“…11 2007: Posttransplant astigmatism and effects of relaxing incisions. 40 2009-2020: Corneal guttata, 78 challenging cataract surgery, 79 and corneal edema after cataract surgery 32 as predisposing factors of corneal transplant.…”

“…78 Moreover, for patients with or without guttata, the relative risk of corneal transplant increased over 3-fold for dense cataracts requiring trypan blue staining or if posterior capsular rupture occurred. 79…”

“…98 Future keratoplasty registries could be further reinforced by record linkage between credible registries, as observed in the Swedish cataract and corneal transplant registries and the UK socioeconomic analyses. 32,63,78,79,99 The incorporation of imaging databases or biosample collection with registry data could also foster more extensive scientific discovery. 100 In addition, the registry should have a transparent data-sharing policy that increases the pace of knowledge discovery and progress.…”

Incidence and Risk Factors of Corneal Endothelial Failure after Phacoemulsification in Patients with Fuchs Endothelial Corneal Dystrophy: A 13-Year Retrospective Cohort

“…However, corneal endothelial cells can be injured after cataract extraction with phacoemulsification due to long phacoemulsification time, hard nucleus, posterior capsular rupture. [5][6][7] Therefore, there are additional concerns of accelerated endothelial cells loss due to cataract surgery in patients with FECD. [8][9][10] The American Academy of Ophthalmology (AAO) Preferred Practice Pattern recommendation suggests that there is an increased likelihood of corneal failure following cataract surgery in patients with central corneal pachymetry greater than 640 microns.…”