Abstract
Purpose :
To compare differences in outcomes following keratorefractive surgery in patients who used glucocorticoids for the 12 months preceding surgery, and those who did not.
Methods :
A retrospective cohort study was conducted using TriNetX (Cambridge, MA, USA), a federated electronic health record research network comprising multiple large health organizations in the US. Patients who underwent keratorefractive surgery were identified by CPT code and stratified cohorts based on glucocorticoid use. Cohorts were matched for age, gender, and comorbidities (essential hypertension, diabetes mellitus, cerebrovascular disease, heart failure, nicotine dependence, alcohol related disorders, and body mass index). Primary outcomes were Dry Eye Syndrome, Recurrent Corneal Erosion, Corneal Edema, Corneal Scar or Opacity, Corneal Ectasia, Acute Conjunctivitis, Diffuse Lamellar Keratitis, Corneal Neovascularization, Vitreous Degeneration (VD), Vitreous Hemorrhage (VH), Retinal Detachment or Break(RD/B), Retinal Edema, and Cystoid Macular Degeneration (CMD). Outcomes were compared between cohorts after propensity score matching using logistic regression and greedy nearest-neighbor matching algorithm.
Results :
A total of 13,704 patients were included in analysis with 6,852 in each cohort after propensity matching. The glucocorticoid use cohort had a significantly greater risk of developing dry eye syndrome (RR, 1.61; 95% CI, 2.79-4.59), corneal neovascularization (RR,2.1; 95% CI, 0.99-4.46), vitreous degeneration (RR, 1.43; 95% CI, 1.17-1.75), vitreous hemorrhage (RR,1.82; 95% CI, 1.08-3.06), retinal detachment or break (RR,2.15; 95% CI, 1.61-2.87), retinal edema (RR, 2.17; 95% CI, 1.24-3.78), and cystoid macular degeneration (RR,1.98; 95% CI, 1.38-2.83). No significant difference was seen in development of recurrent corneal erosions, corneal edema, corneal scar, corneal ectasia, acute conjunctivitis, diffuse lamellar keratitis, or ischemic optic neuropathy.
Conclusions :
Glucocorticoid use is an important consideration when evaluating for postoperative complications following keratorefractive surgery. Glucocorticoid users were more likely to develop dry eye, corneal neovascularization, VD, VH, RD/B, retinal edema, and CMD. These differences should be considered when evaluating patients and discussing outcomes with patients both pre and post-operatively.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.