Retinal Detachment Rates and Clinical Outcomes Following Penetrating and Endothelial Keratoplasty

Abstract

Purpose : To evaluate retinal detachment rates and clinical outcomes after penetrating keratoplasty (PK) and endothelial keratoplasty (EK).

Methods : The medical and billing records of a group of academic private practices were electronically queried for all surgical visits during which a PK or EK was performed between April 1, 2012 and August 31, 2018 for this retrospective cohort study. Demographic information and transplant characteristics were recorded for each patient and office visit. An additional query was performed to identify all cases of retinal detachment based on diagnosis and procedure billing codes. Charts of patients with retinal detachment were individually reviewed, and information was collected on prior clinical history, clinical evaluation at presentation, surgical management, visual outcomes, and graft survival rates. The main outcome measure was incidence of retinal detachment following PK or EK.

Results : During the study period, 1,676 PKs and 2,292 EKs for 3,069 patients were performed. The mean age of patients in this transplant cohort was 66.4 (± 17.5) years and 54.6% of patients were female. Fifty-two cases of rhegmatogenous retinal detachment occurred during the study period; forty-one cases occurred after PK and eleven cases occurred after EK. The rate of retinal detachment after EK (11 of 2,292; 0.5%) was significantly lower than that after PK (41 of 1,676; 2.4%) (p < 0.001). Additionally, the odds of developing retinal detachment after PK or EK performed in conjunction with anterior or pars plana vitrectomy were significantly higher than after either PK or EK alone (OR: 8.66; 95% CI: 2.98-25.18; p < 0.001). Nineteen eyes were determined to have inoperable retinal detachments and one did not have sufficient follow up. Therefore, thirty-two eyes were included in the clinical outcomes analysis. Visual acuity outcomes were worse after PK related retinal detachment than EK associated cases although this difference was not statistically significant.

Conclusions : In this large cohort of patients undergoing either PK or EK, rates of retinal detachment were low for both procedures and significantly lower for EK compared to PK. Eyes with retinal detachment after PK had worse visual acuity outcomes and graft prognosis compared to those with retinal detachment after EK.

This is a 2020 ARVO Annual Meeting abstract.