Incidence of corneal transplantation after challenging cataract surgery in patients with and without corneal guttata

Purpose: To study the risk for corneal transplantation after phacoemulsification with dense cataract or posterior capsule rupture (PCR) and the impact of corneal guttata. Setting: Forty-nine Swedish cataract surgical units and 8 Swedish cornea transplantation units. Design: Registry-based cohort study. Methods: Patient data from the Swedish National Cataract Registry (2010 to 2012) were linked with data from the Swedish Cornea Transplant Registry (2010 to 2017). The outcome measures were risk for future corneal transplantation, visual acuity, and sel f-assessed visual function after phacoemulsification. Logistic and Poisson regression analyses with adjustment for confounder effects were used to investigate the association of the outcome measures with dense cataract, indicated by trypan blue capsular staining (TB) and PCR, separately and together. Results: Altogether, data from 276 362 cataract patients were linked with data from 2091 patients with endothelial failure who underwent corneal transplantation.The risk for future corneal transplantation increased more than 3-fold with the presence of dense cataract or PCR, and a trend toward an ever-higher risk with the combination of TB and PCR together, but without any significant synergy of corneal guttata. Dense cataract, but not PCR, was significantly associated with an increased probability of inferior visual acuity after phacoemulsification. The impact on satisfaction was not statistically significant for any of the factors. Conclusions: Challenging cataract surgery increases the risk for future corneal transplantation equally in patients both with and without corneal guttata, despite a more vulnerable endothelium in the guttata group. This supports a strategy where PCR is limited and handled optimally and that cataract surgery is performed before the cataract turns critically dense. J Cataract Refract Surg 2021; 47:358-365 Copyright (c) 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS