The incidence of major postoperative complications, including endophthalmitis, retinal detachment and choroidal hemorrhage, following endothelial keratoplasty (EK) procedures is low, a recent study suggests. Despite this finding, researchers noted that a high proportion of eyes undergoing EK eventually require glaucoma surgery and experience graft-related complications.

This retrospective cohort study included 71,040 patients (29% had pre-existing glaucoma) who underwent a total of 94,829 EK procedures. A team evaluated the occurrence of major postoperative complications following EK surgery, time-to-event data for glaucoma surgery and the occurrence of graft complications.

The investigators reported overall 90-day cumulative incidences of postoperative endophthalmitis and choroidal hemorrhage following EK of 0.03% and 0.05%, respectively. They noted that the overall one-year cumulative incidences of retinal detachment and related surgery, infectious keratitis and cystoid macular edema were 1.0%, 0.8% and 4.1%, respectively.

They found that approximately 7.6%, 12.2% and 13.8% of all eyes needed glaucoma surgery at one, five and eight years of follow-up, respectively. They added that the probabilities of glaucoma surgery among patients with and without pre-existing glaucoma were 29% vs. 8%, respectively, at eight years. The chance of developing graft complications was 13%, 23.2% and 27.1% at one, five and eight years of follow-up.

On average, they concluded that patients undergoing EK procedures for a prior failed graft had the highest rate of complications, while those with Fuch’s corneal endothelial dystrophy had the lowest.

Zafar S, Wang P, Woreta FA, et al. Postoperative complications in Medicare beneficiaries following endothelial keratoplasty (EK) surgery. Am J Ophthalmol. June 20, 2020. [Epub ahead of print].