Cornea guttata linked to transplant after phaco
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The risk for corneal transplantation after phacoemulsification was nearly 70% higher for patients with cornea guttata than those without, although most patients with cornea guttata did not undergo transplantation.
“Fuchs endothelial corneal dystrophy (FECD) is a bilateral degenerative corneal disease. With progression, endothelial decompensation with corneal swelling occurs, leading to visual impairment,” Andreas Viberg, MD, from Umeå University, Umeå, Sweden, and colleagues wrote. “The irregularity of the corneal endothelium known as cornea guttata is seen early in FECD, but can also occur with aging, trauma, inflammation and glaucoma.”
Among 192,253 patients who underwent phacoemulsification, 152 of 3,338 patients with cornea guttata also underwent corneal transplantation during the study period, as published in Journal of Cataract and Refractive Surgery.
During the first year after phacoemulsification, the incidence rate of corneal transplantation after phacoemulsification among patients with cornea guttata was 171.6 per 10,000 person years (95% CI, 129.6-222.8), while the overall incidence rate was 88 per 10,000 person years (95% CI, 74.5-103.1), as the annual incidence rate diminished after 1 year.
In comparison, 0.1% of 188,915 patients without registered cornea guttata underwent a corneal transplantation during the study period. The overall incidence rate of corneal transplantation among this group was 1.4 per 10,000 person years (95% CI, 1.2-1.6).
The researchers determined that phacoemulsification in patients with cornea guttata correlated with corneal transplantation (adjusted relative risk = 68.2; 95% CI, 54-86.2). Additionally, increasing age at the time of phacoemulsification had a gradually decreasing probability of corneal transplantation.
“Even if both patients with and without cornea guttata benefit from cataract surgery, they suffer from endothelial cell loss, and the results for the cornea guttata group are worse,” Viberg and colleagues wrote. “It is of great interest to study the risk for corneal transplantation the first years after cataract surgery in patients with cornea guttata, as a transplantation deals with a more complex postoperative course that in a way lasts for life.” – by Talitha Bennett
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Kyle A. Sandberg, OD, FAAO
As primary eye care providers, the earliest discussions about cataract management are frequently handled by optometrists, and this study helps to impact those counseling sessions. It found, in the analysis of more than a quarter million cataract surgery cases, that patients with corneal guttata have a 68-times greater risk for corneal transplant than those without guttata after phacoemulsification.
While the overall likelihood of transplant in all cohorts is still exceedingly low, this increased risk should be reflected in preop patient education. Further, as we discuss the need to initiate surgical treatment of cataracts, clinical evidence of endothelial dysfunction should influence the practitioner’s advice about the timing of treatment. Put simply, when progressive corneal guttata is present, we should consider surgical intervention earlier. A final takeaway is that if a patient is going to ultimately require a corneal transplant, it is most likely to occur in younger patients and within the first year after phacoemulsification, highlighting the importance of careful monitoring of these cataract postops in the initial 12 months.
The study did not address the influence of newer surgical techniques such as laser-assisted cataract surgery, which reduces total phaco energy and time, thus offering at-risk patients a potential avenue for improved outcomes.
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