National outcomes of penetrating keratoplasty. Risks of endophthalmitis and retinal detachment.
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.
Aiello
L P
LP
Wilmer Ophthalmological Institute, Johns Hopkins University Hospital, Baltimore, Md.
Javitt
J C
JC
Canner
J K
JK
D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D006278:Medicare; D012163:Retinal Detachment / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014821:Vitrectomy