Incidence of corneal transplantation after phacoemulsification in patients with cornea guttata: registry-based cohort study.

PURPOSE: To investigate the risk of corneal transplantation after phacoemulsification related to cornea guttata. SETTING: University hospital, Sweden. DESIGN: Registry-based cohort study. METHODS: Patient data from the Swedish National Cataract Registry (NCR) between 2010 and 2012 were linked with data from the Swedish Cornea Transplant Registry (SCTR) between 2010 and September 2017. Data from cataract patients were linked with data from patients who underwent corneal transplantation due to endothelial failure. Triple procedure and other surgical methods for cataract extraction other than phacoemulsification were excluded. If both eyes had surgery, 1 eye was randomly selected from the registry to obtain unrelated samples. The incidence was calculated per 10,000 person years and Poisson regression analysis was used to investigate the risk for corneal transplantation due to endothelial failure after phacoemulsification. RESULTS: Altogether, data from 276,362 cataract patients were linked with data from 2,091 patients who underwent corneal transplantation. The incidence rate of corneal transplantation after phacoemulsification among patients with cornea guttata was 88/10,000 person years (95% CI: 74.5-103.1). The annual incidence rate was highest the first year and diminished thereafter. The incidence rate of corneal transplantation among patients without cornea guttata was 1.4/10,000 person years (95% CI: 1.2-1.6). Phacoemulsification in patients with cornea guttata was associated with corneal transplantation with an adjusted relative risk of 68.2 (95% CI: 54.0-86.2). CONCLUSIONS: The relative risk of corneal transplantation after phacoemulsification was 68.2 times higher for patients with cornea guttata than without. Still, the great majority of the patients with cornea guttata did not undergo corneal transplantation during the study period.