Abstract
Purpose :
Cataract surgery may result in endothelial cell loss and corneal decompensation. In adults, corneal transplantation following cataract surgery may occur in the setting of Fuchs dystrophy and pseudophakic bullous keratopathy.1 The indications for corneal transplantation following pediatric cataract surgery are not well understood. This study aims to describe the incidence of corneal transplantation following pediatric cataract surgery and to identify associated demographic and clinical factors.
Methods :
This retrospective cohort study included patients in the IRIS® Registry (Intelligent Research in Sight) who underwent cataract surgery at ≤18 years of age and between January 2013 and December 2020. Cataract and corneal transplant surgeries were identified using Current Procedure Terminology codes. The Kaplan-Meier estimator was used to calculate the five-year cumulative incidence of corneal transplantation following cataract surgery. Cox Proportional Hazards regression was used to identify demographic and clinical factors associated with corneal transplantation.
Results :
Cataract surgery was performed on 7657 children (median age 11.0 years; 45.9% female) included in this study. The five-year incidence of corneal transplant following pediatric cataract surgery was 0.4% (95% CI, 0.2% to 0.6%). This incidence did not differ based on age, sex, geographic region, or cataract surgery laterality. However, the incidence was greater in aphakic patients (1.4%; 95% CI, 0.5% to 2.3%) compared to pseudophakic patients (0.2%; 95% CI, <0.1% to 0.4%). Children ≥6 years old who did not have an intraocular lens placed during cataract surgery had an increased risk of undergoing a corneal transplant within five years (HR, 2.10; 95% CI, 0.412 to 3.75; P<0.001).
Conclusions :
This large registry-based analysis found that approximately 1 in 400 children underwent corneal transplantation within five years of cataract surgery. Traumatic injuries involving the lens and cornea may contribute to the increased incidence of corneal transplantation in older children who undergo cataract surgery without intraocular lens placement.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.