Abstract
Purpose :
To identify demographic and systemic risk factors associated with diabetes in developing corneal edema and/or requiring corneal transplantation following cataract surgery.
Methods :
Data was collected from a nationwide sample of Medicare beneficiaries aged 65 and above from 2011-2015. Patients who received cataract surgery between the years of 2011-2014 with at least 1 year of follow-up were identified (N = 192,150). Age, gender, race/ethnicity, tobacco use, and hypertension diagnosis were collected. Diabetes status along sequelae including renal, ophthalmic, and vascular involvement were identified using International Classification of Disease (ICD-9) codes. Multivariable logistic regression models assessed relationship between demographic factors and diabetic sequelae on the development of corneal edema and subsequent need for corneal transplantation.
Results :
Patients with diabetes were more likely to develop corneal edema compared to non-diabetic patients after cataract surgery (Odds ratio [OR] 1.25, 95% Confidence Interval [1.07-1.46]). Compared to patients aged 65-74, patients aged 75-84 (OR 1.38 [1.18-1.61]) and over 85 (OR 2.40 [1.93-2.97]) were more likely to develop corneal edema. Compared to White patients, Black, Asian, Hispanic, and North American Native patients were significantly more likely to develop both corneal edema (OR 1.75 [1.36-2.21], 2.69 [1.89-3.71], 2.80 [1.90-3.96], 3.32 [1.65-5.90] respectively) and eventually require corneal transplantation (OR 1.99 [1.05-3.45], 4.32 [2.02-8.15], 4.81[2.13-9.35], 6.35 [1.55-17.00] respectively). Females had lower odds of requiring corneal transplantation post-operatively (OR 0.53 [0.37-0.76]). In diabetic patients, the presence of macular edema was associated with increased odds of developing corneal edema (OR 1.86 [1.14-2.98]). The severity of diabetic retinopathy, diabetic kidney disease, and the presence of peripheral circulatory disease were not associated with increased odds of corneal edema.
Conclusions :
Older age and diabetes increase the risk of developing corneal edema after cataract surgery. Amongst diabetic patients, the presence of macular edema was further associated with an increases risk of corneal edema. Further research is needed to understand the factors underlying the significantly increased risk of corneal edema in racial and ethnic minorities within the United States
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.