Within a Medicare fee-for-service population, a large, retrospective study found that patients who underwent penetrating keratoplasty or anterior lamellar keratoplasty were more than 5 times more likely to develop post–corneal transplant endophthalmitis than those who underwent endothelial keratoplasty, among other risk factors identified, though the overall risk of endophthalmitis was still very low.
Study Design
This was a retrospective study that utilized a 100% Medicare fee-for-service database to identify patients who underwent corneal transplantation between January 1, 2016, and December 31, 2019 (N = 54,822). The study evaluated rates of endophthalmitis within 42 days of transplantation relative to both patient-specific (e.g., sociodemographic, medical) and surgeon-specific (e.g., sex, surgical volume, location) factors.
Outcomes
Overall, 0.39% of patients developed endophthalmitis a median of 14 days after surgery. Compared to endothelial keratoplasty, the odds of endophthalmitis were greater after penetrating keratoplasty (OR = 5.46) and anterior lamellar keratoplasty (OR = 5.45). An additional risk factor for endophthalmitis was a Charlson Comorbidity Index (CCI) of at least 3 (OR = 1.82) relative to a CCI of 0. Practices in the Midwest (OR = 0.59), West (OR = 0.57), and Northeast (OR = 0.59) regions of the United States showed lower rates of endophthalmitis in comparison to practices in the South.
Limitations
Important variables such as indication for keratoplasty, surgery length, use of antibiotics, donor variables, and rim culture results were not evaluated. Furthermore, the study is limited by the absence of data from patients with alternative types of Medicare plans. Exclusively including patients 65 years of age or older may also have resulted in findings that are not generalizable to younger populations.
Clinical Significance
The analyses from this study may help guide surgeons when they counsel patients on the risk of this vision-threatening complication after corneal transplantation. In addition, the outcomes could potentially contribute to benchmarks for assessing the success of corneal transplants in various regions.
Financial Disclosures: Dr. Zeba Syed discloses financial relationships with Bio-Tissue, Recordati Rare Diseases (Consultant/Advisor, Lecture Fees/Speakers Bureau); Dompe, Glaukos (Grant Support); Tarsus Pharmaceuticals (Lecture Fees/Speakers Bureau).