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National Outcomes of Penetrating Keratoplasty: Risks of Endophthalmitis and Retinal Detachment

National Outcomes of Penetrating Keratoplasty: Risks of Endophthalmitis and Retinal Detachment Abstract • We studied rehospitalization for endophthalmitis or retinal detachment (RD) in 40 351 Medicare beneficiaries who were admitted to US hospitals for penetrating keratoplasty (PK) between 1984 and 1987. This cohort represents 56.5% of all PKs performed during this period for recipients of age to receive Medicare benefits. Penetrating keratoplasty was combined with intracapsular cataract extraction in 1188 patients (2.9%) and with extracapsular cataract extraction in 7038 patients (17.4%). Anterior vitrectomy was performed in 8428 patients (20.9%). The risk of rehospitalization for endophthalmitis within 6 months of PK was 0.77%. Concurrent anterior vitrectomy increased this risk to 1.03% (P=.004). The risk of rehospitalization for RD within 2 years of PK was 1.85%. Concurrent anterior vitrectomy increased this risk to 2.49% (P=.0001). Combined PK and intracapsular cataract extraction demonstrated a 3.9-fold increased rate of RD compared with PK and extracapsular cataract extraction (P=.0001). Anterior vitrectomy with PK and extracapsular cataract extraction increased the risk of RD 4.3-fold compared with PK and extracapsular cataract extraction alone (P=.007). Men were at a 68% higher risk of RD than women (P=.0001). The risk of rehospitalization for endophthalmitis following PK is five times higher and the risk of RD two times higher than that reported following cataract surgery. Anterior vitrectomy, however, results in similar risk increases following either surgery. References 1. Cummings CE. Corneal Graft Statistics . Washington, DC: Eye Bank Association of America; 1992. 2. 1987 Activity Report . Washington, DC: Eye Bank Association of America; 1988. 3. Cameron JA, Antonios SR, Cotter JB, et al. Endophthalmitis from contaminated donor corneas following penetrating keratoplasty . Arch Ophthalmol . 1991;109:54-59.Crossref 4. Guss RB, Koenig S, De La Pena W, et al. Endophthalmitis after penetrating keratoplasty . Am J Ophthalmol . 1983;95:651-658. 5. Leveille AS, McMullian FD, Cavanagh HD. Endophthalmitis following penetrating keratoplasty . Ophthalmology . 1983;90:38-39.Crossref 6. Musch DC, Meyer RF, Sugar A, et al. Retinal detachment following penetrating keratoplasty . Arch Ophthalmol . 1986;104:1617-1620.Crossref 7. Forstot SL, Binder PS, Fitzgerald C, et al. The incidence of retinal detachment after penetrating keratoplasty . Am J Ophthalmol . 1975;80:102-105. 8. Sternberg P, Meredith TA, Stewart MA, et al. Retinal detachment in penetrating keratoplasty . Am J Ophthalmol . 1990;109:148-152. 9. Division of Quality Control Management, American Hospital Association. International Classification of Diseases, Ninth Revision, Clinical Modification . Chicago, Ill: American Hospital Publishing Inc; 1989. 10. Javitt JC, Vitale S, Canner JK, et al. National outcomes of cataract extraction, I: retinal detachment after inpatient surgery . Ophthalmology . 1991;98:895-902.Crossref 11. Javitt JC, Vitale S, Canner JK, et al. National outcomes of cataract extraction: endophthalmitis following inpatient surgery . Arch Ophthalmol . 1991;109:1085-1089.Crossref 12. Scheie HG, Morse PH, Aminlari A. Incidence of retinal detachment following cataract extraction . Arch Ophthalmol . 1973;89:293-295.Crossref 13. Everett WG, Hurite FG, Sorr EM. Retinal detachment following cataract extraction by phacoemulsification . Mod Probl Ophthalmol . 1977;18:503-507. 14. Kraff MC, Sanders DR, Lieberman HL. Total cataract extraction through a 3-mm incision: a report of 650 cases . Ophthalmic Surg . 1979;10:46-54. 15. Kilkinson CP, Anderson LS, Little JH. Retinal detachment following phacoemulsification . Ophthalmology . 1978;85:151-156.Crossref 16. Wise JB. Retinal detachment after phacoemulsification . Ophthalmology . 1979;86:2007-2010.Crossref 17. Hurite FG, Sorr EM, Everett WG. The incidence of retinal detachment following phacoemulsification . Ophthalmology . 1979;86:2004-2006.Crossref 18. Shepard DD. Retinal detachment with intraocular lenses . J Am Intraocul Implant Soc . 1978;4:55.Crossref 19. Wetzig PC, Thatcher DB, Christiansen JM. The intracapsular versus the extracapsular cataract technique in relationship to retinal problems . Trans Am Ophthalmol Soc . 1979;77:339-347. 20. Coonan P, Fung WE, Webster RG Jr, et al. The incidence of retinal detachment following extracapsular cataract extraction: a ten-year study . Ophthalmology . 1985;92:1096-1101.Crossref 21. Clayman HM, Jaffe NS, Light DS, et al. Intraocular lenses, axial length, and retinal detachment . Am J Ophthalmol . 1981;92:778-780. 22. Percival SPB. Long term complications from extracapsular cataract surgery . Trans Ophthalmol Soc UK . 1985;104:915-918. 23. Percival SPB, Anand V, Das SK. Prevalence of aphakic retinal detachment . Br J Ophthalmol . 1983;67:43-45.Crossref 24. Heslin KB, Guerriero PN. Clinical retrospective study comparing planned extracapsular cataract extraction and phacoemulsification with and without lens implantation . Ann Ophthalmol . 1984;16:956-962. 25. Ridgway AEA. Discussion of factors responsible for retinal detachment and other late complications after intraocular lens implantation . Trans Ophthalmol Soc U K . 1985;104:539-540. 26. McConnell JMS, Cullen JF. Posterior chamber intraocular lens implantation: further review of the Severin lens . Trans Ophthalmol Soc U K . 1985;104:912-914. 27. Laatikainen L, Tarkkanen A. Proliferative vitreoretinopathy after intraocular lens implantation . Acta Ophthalmol . 1985;63:380-382.Crossref 28. Naeser K, Kobayashi C. Epidemiology of aphakic retinal detachment following intracapsular cataract extraction: a follow-up study with an analysis of risk factors . J Cataract Refract Surg . 1988;14:303-308.Crossref 29. Davison JA. Retinal tears and detachments after extracapsular cataract surgery . J Cataract Refract Surg . 1988;14:624-632.Crossref 30. Smith PW, Stark WJ, Maumenee AE, et al. Retinal detachment after extracapsular cataract extraction with posterior chamber intraocular lens . Ophthalmology . 1987;94:495-504.Crossref 31. Fine M. Problems of keratoplasty in aphakic eye . In: Bellows JG, ed. Contemporary Ophthalmology Honoring Sir Stewart Duke-Elder . Baltimore, Md: Williams & Wilkins; 1972:138-143. 32. Dupont WD. Randomized vs historical clinical trials: are the benefits worth the cost? Am J Epidemiol . 1985;122:940. 33. Fisher ES, Whaley FS, Krushat WM, et al. The accuracy of Medicare's hospital claims data: progress has been made but problems remain . Am J Public Health . 1992:82:243-248.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

National Outcomes of Penetrating Keratoplasty: Risks of Endophthalmitis and Retinal Detachment

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1993.01090040101041
Publisher site
See Article on Publisher Site

Abstract

Abstract • We studied rehospitalization for endophthalmitis or retinal detachment (RD) in 40 351 Medicare beneficiaries who were admitted to US hospitals for penetrating keratoplasty (PK) between 1984 and 1987. This cohort represents 56.5% of all PKs performed during this period for recipients of age to receive Medicare benefits. Penetrating keratoplasty was combined with intracapsular cataract extraction in 1188 patients (2.9%) and with extracapsular cataract extraction in 7038 patients (17.4%). Anterior vitrectomy was performed in 8428 patients (20.9%). The risk of rehospitalization for endophthalmitis within 6 months of PK was 0.77%. Concurrent anterior vitrectomy increased this risk to 1.03% (P=.004). The risk of rehospitalization for RD within 2 years of PK was 1.85%. Concurrent anterior vitrectomy increased this risk to 2.49% (P=.0001). Combined PK and intracapsular cataract extraction demonstrated a 3.9-fold increased rate of RD compared with PK and extracapsular cataract extraction (P=.0001). Anterior vitrectomy with PK and extracapsular cataract extraction increased the risk of RD 4.3-fold compared with PK and extracapsular cataract extraction alone (P=.007). Men were at a 68% higher risk of RD than women (P=.0001). The risk of rehospitalization for endophthalmitis following PK is five times higher and the risk of RD two times higher than that reported following cataract surgery. Anterior vitrectomy, however, results in similar risk increases following either surgery. References 1. Cummings CE. Corneal Graft Statistics . Washington, DC: Eye Bank Association of America; 1992. 2. 1987 Activity Report . Washington, DC: Eye Bank Association of America; 1988. 3. Cameron JA, Antonios SR, Cotter JB, et al. Endophthalmitis from contaminated donor corneas following penetrating keratoplasty . Arch Ophthalmol . 1991;109:54-59.Crossref 4. Guss RB, Koenig S, De La Pena W, et al. Endophthalmitis after penetrating keratoplasty . Am J Ophthalmol . 1983;95:651-658. 5. Leveille AS, McMullian FD, Cavanagh HD. Endophthalmitis following penetrating keratoplasty . Ophthalmology . 1983;90:38-39.Crossref 6. Musch DC, Meyer RF, Sugar A, et al. Retinal detachment following penetrating keratoplasty . Arch Ophthalmol . 1986;104:1617-1620.Crossref 7. Forstot SL, Binder PS, Fitzgerald C, et al. The incidence of retinal detachment after penetrating keratoplasty . Am J Ophthalmol . 1975;80:102-105. 8. Sternberg P, Meredith TA, Stewart MA, et al. Retinal detachment in penetrating keratoplasty . Am J Ophthalmol . 1990;109:148-152. 9. Division of Quality Control Management, American Hospital Association. International Classification of Diseases, Ninth Revision, Clinical Modification . Chicago, Ill: American Hospital Publishing Inc; 1989. 10. Javitt JC, Vitale S, Canner JK, et al. National outcomes of cataract extraction, I: retinal detachment after inpatient surgery . Ophthalmology . 1991;98:895-902.Crossref 11. Javitt JC, Vitale S, Canner JK, et al. National outcomes of cataract extraction: endophthalmitis following inpatient surgery . Arch Ophthalmol . 1991;109:1085-1089.Crossref 12. Scheie HG, Morse PH, Aminlari A. Incidence of retinal detachment following cataract extraction . Arch Ophthalmol . 1973;89:293-295.Crossref 13. Everett WG, Hurite FG, Sorr EM. Retinal detachment following cataract extraction by phacoemulsification . Mod Probl Ophthalmol . 1977;18:503-507. 14. Kraff MC, Sanders DR, Lieberman HL. Total cataract extraction through a 3-mm incision: a report of 650 cases . Ophthalmic Surg . 1979;10:46-54. 15. Kilkinson CP, Anderson LS, Little JH. Retinal detachment following phacoemulsification . Ophthalmology . 1978;85:151-156.Crossref 16. Wise JB. Retinal detachment after phacoemulsification . Ophthalmology . 1979;86:2007-2010.Crossref 17. Hurite FG, Sorr EM, Everett WG. The incidence of retinal detachment following phacoemulsification . Ophthalmology . 1979;86:2004-2006.Crossref 18. Shepard DD. Retinal detachment with intraocular lenses . J Am Intraocul Implant Soc . 1978;4:55.Crossref 19. Wetzig PC, Thatcher DB, Christiansen JM. The intracapsular versus the extracapsular cataract technique in relationship to retinal problems . Trans Am Ophthalmol Soc . 1979;77:339-347. 20. Coonan P, Fung WE, Webster RG Jr, et al. The incidence of retinal detachment following extracapsular cataract extraction: a ten-year study . Ophthalmology . 1985;92:1096-1101.Crossref 21. Clayman HM, Jaffe NS, Light DS, et al. Intraocular lenses, axial length, and retinal detachment . Am J Ophthalmol . 1981;92:778-780. 22. Percival SPB. Long term complications from extracapsular cataract surgery . Trans Ophthalmol Soc UK . 1985;104:915-918. 23. Percival SPB, Anand V, Das SK. Prevalence of aphakic retinal detachment . Br J Ophthalmol . 1983;67:43-45.Crossref 24. Heslin KB, Guerriero PN. Clinical retrospective study comparing planned extracapsular cataract extraction and phacoemulsification with and without lens implantation . Ann Ophthalmol . 1984;16:956-962. 25. Ridgway AEA. Discussion of factors responsible for retinal detachment and other late complications after intraocular lens implantation . Trans Ophthalmol Soc U K . 1985;104:539-540. 26. McConnell JMS, Cullen JF. Posterior chamber intraocular lens implantation: further review of the Severin lens . Trans Ophthalmol Soc U K . 1985;104:912-914. 27. Laatikainen L, Tarkkanen A. Proliferative vitreoretinopathy after intraocular lens implantation . Acta Ophthalmol . 1985;63:380-382.Crossref 28. Naeser K, Kobayashi C. Epidemiology of aphakic retinal detachment following intracapsular cataract extraction: a follow-up study with an analysis of risk factors . J Cataract Refract Surg . 1988;14:303-308.Crossref 29. Davison JA. Retinal tears and detachments after extracapsular cataract surgery . J Cataract Refract Surg . 1988;14:624-632.Crossref 30. Smith PW, Stark WJ, Maumenee AE, et al. Retinal detachment after extracapsular cataract extraction with posterior chamber intraocular lens . Ophthalmology . 1987;94:495-504.Crossref 31. Fine M. Problems of keratoplasty in aphakic eye . In: Bellows JG, ed. Contemporary Ophthalmology Honoring Sir Stewart Duke-Elder . Baltimore, Md: Williams & Wilkins; 1972:138-143. 32. Dupont WD. Randomized vs historical clinical trials: are the benefits worth the cost? Am J Epidemiol . 1985;122:940. 33. Fisher ES, Whaley FS, Krushat WM, et al. The accuracy of Medicare's hospital claims data: progress has been made but problems remain . Am J Public Health . 1992:82:243-248.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Apr 1, 1993

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