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M. Claesson, J. Armitage; PKP for Corneal Oedema Following Cataract Surgery. Data from the Swedish Cornea Transplant Register . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2369.
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© ARVO (1962-2015); The Authors (2016-present)
Twenty percent of the corneal transplants in Sweden are for pseudophakic or aphakic bullous keratopathy. Their outcome is worse than for PK for Fuchs’ dystrophy in a similarly aged group of patients. The aim of this investigation was to find those factors that influenced graft survival and visual outcome in these patients.
Details of previous cataract surgery were obtained from the medical records of 273 patients grafted for bullous keratopathy. The Swedish Corneal Transplant Register provided data (preoperative and 2–year postoperative) about the PK. The impact of factors on graft survival and whether visual acuity was better than 0.1 (20/200) were analyzed by multiple logistic regression analysis.
In this cohort of patients, 43% had corneal oedema that failed to clear after their cataract surgery. This was more likely if there was pre–existing endothelial disease (p=0.002) and glaucoma (p=0.019), and less likely for ECCE than phacoemulsification (p<0.001). Graft failure within two years of PK was more likely with increasing age at the time of PK (p=0.027), rejection episodes (p=0.001), complications at PK surgery (p=0.002), if the PK was done for pain relief (p=0.037), if the cataract surgery had been ICCE (p=0.031), and if glaucoma was present before the cataract surgery (p=0.009). The risk of subsequent graft failure was less with increasing age at the time of cataract surgery (p=0.027), and with increasing time between cataract surgery and PK (p=0.029). Visual acuity >0.1 two years after PK was less likely with increasing age at the time of the cataract surgery (p=0.036), with increasing duration of bullous keratopathy (p=0.017), where the reason for the PK was pain relief (p=0.011), where rejection episodes were reported (p=0.048) and with sight–hindering co–morbidity (p<0.001).
Patients with pre–existing endothelial disease and glaucoma who underwent phacoemulsification were more likely to suffer immediate corneal oedema after cataract surgery. The first two factors along with patient age, ICCE, duration of bullous keratopathy, the reason for PK, complications at PK and rejection episodes impacted on subsequent graft survival and VA.
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