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T. C. Bailey, G. W. Zaidman, B. Mirochnik, R. Naadimuthu; The Incidence of Cataract Extraction Following Corneal Transplantation in Young and Middle-Aged Patients. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2207.
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This study will analyze the incidence of and risk factors leading to cataract extraction (CE) in patient 25 to 65 years old that required corneal transplant surgery (CTS).
A retrospective chart review was performed of all CTS performed between December 1997 and January 2007. Patient's were divided into three age groups: 25 to 35 years of age, 36 to 50 years old, and 51 to 65 years old and then analyzed for the incidence of CE. Risk factors analyzed include preoperative diagnosis, age, complications following CTS, (glaucoma, rejection episodes and complicated anterior segment surgery) and preexisting lens opacity.
195 patients were identified in this age range. The average follow-up after CTS was 4.0 years. There were 58 patients aged 25-35, 82 patients from 36-50, and 55 patients from 51-65. The most common diagnoses were keratoconus (KCN) in 65% of patients, followed by Fuchs dystrophy (FD) in 10%. KCN occurred in 83% of patients aged 25-35, 66% of patients 36 to 50, and 38% of patients 51 to 65. FD occurred in 2% of patients in the 36 to 50 group and 29% of patients in the 51 to 65 group. 6% of patients in the 2 younger age groups had pre-existing lens changes while 69% of patients in the oldest age group had pre-existing lens changes. The total number of CE was 26. There were two CE (3.4%) in group 25 to 35; three CE (3.6%) in group 35 to 50, and 21 CE (38%) in group 51 to 65. 9 of these older patients had FD and five had herpes keratitis. The most common diagnosis in patients not requiring cataract extraction was KCN. The most common diagnoses in patients requiring cataract extractions were FD and herpes keratitis. The patients undergoing CE had complications more often than patients who did not require CE by a ratio of 4:3. However, any individual complication taken alone did not significantly contribute to CE. The average age in patients who did not form cataracts was 37; the average age of patients that required CE was 58 years old. 81% of patients requiring cataract extraction were over the age of 50.
These results help to counsel patients regarding the risk for CE following CTS. Patients under the age of 51 rarely require cataract extraction after corneal transplants. However, nearly 40% of patients older than 55 required CE and in this population the risk is greatest in patients with Fuchs dystrophy. There is also a high risk of CE in all patients undergoing corneal transplant surgery for herpes keratitis. Patients with multiple postoperative complications are also more likely to require cataract surgery.
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