National Outcomes of Cataract Extraction III. Corneal Edema and Transplant Following Inpatient Surgery

We analyzed the likelihood of rehospitalization for corneal edema or corneal transplantation in all 338141 Medicare beneficiaries older than 65 years who were admitted to US hospitals for cataract extraction in 1984. The rate of rehospitalization for corneal edema or transplant within 4 years of intracapsular cataract extraction was 1.4%, almost twice the rate associated with extracapsular extraction (0.63%) or phacoemulsification (0.62%; P<.0001). No significant difference in the rate of corneal transplantation was detected between those undergoing extra-capsular cataract extraction and those undergoing phacoemulsification. Among patients who had intracapsular cataract extraction, those who underwent concurrent intraocular lens implantation surgery had a higher rate of rehospitalization for corneal edema or transplantation than those who did not (1.11% vs 0.86%; P=.0003). However, this difference is only manifest starting at about 3 years after surgery. Among patients who underwent extracapsular cataract extraction and phacoemulsification, however, those who underwent intraocular lens implantation during surgery had a lower rate of corneal edema or transplantation than those who did not (0.47% vs 0.74%; P<.0001). This difference was seen almost immediately after surgery. Cataract surgery accompanied by anterior vitrectomy was associated with a threefold increase in the 4-year rate of corneal edema or transplantation compared with cataract surgery alone (2.42% vs 0.87%; P<.0001).