To determine national-level incidence rates of major postoperative complications following EK procedures, and to stratify these rates based on EK indications over an 8-year period using Medicare claims data.
Retrospective, cohort study METHODS: .
Population-based STUDY POPULATION: Medicare beneficiaries aged ≥65 years who underwent EK procedures MAIN OUTCOME MEASURE(S): 1) Occurrence of major postoperative complications (i.e. endophthalmitis, choroidal hemorrhage, infectious keratitis, cystoid macular edema [CME], retinal detachment/retinal detachment [RD] surgery) following EK surgery, 2) time-to-event analysis for glaucoma surgery and, 3) occurrence of graft complications.
A total of 94,829 EK procedures (N= 71,040 unique patients) were included in the analysis. 29% of patients had pre-existing glaucoma. The overall 90-day cumulative incidence of postoperative endophthalmitis and choroidal hemorrhage following EK was 0.03% and 0.05%, respectively. The overall 1-year cumulative incidence of RD/RD surgery, infectious keratitis and CME was 1.0%, 0.8% and 4.1%, respectively. Approximately 7.6%, 12.2% and 13.8% of all eyes in our study population needed glaucoma surgery at 1-, 5- and 8-years of follow up, respectively. The probability of glaucoma surgery among patients with pre-existing glaucoma was 29% vs. 8% among those without pre-existing glaucoma at 8 years. The cumulative probability of developing any graft complications was 13%, 23.2% and 27.1% at 1-, 5- and 8-years of follow up. On average, patients undergoing EK procedures for a prior failed graft had the highest rate of complications, whereas those with Fuchs corneal endothelial dystrophy (FCED) had the lowest.
The incidence of major postoperative complications including endophthalmitis, retinal detachment and choroidal hemorrhage following EK procedures is low. A high proportion of eyes undergoing EK eventually require glaucoma surgery and experience graft-related complications. Postoperative outcomes are typically worse for patients undergoing EK for prior failed grafts compared to those undergoing EK for FCED.

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