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  • Factors Linked to Keratoplasty for Fuchs

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, January 2023

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    In recent years, endothe­lial keratoplasty (EK) has eclipsed penetrating keratoplasty (PK) as the preferred treatment for Fuchs endothelial corneal dystrophy (FECD). Previous work by Heckenlaible et al. showed that among Medicare mem­bers, White patients were twice as likely as Black patients to receive surgery for FECD. In a newer study, the same investigators mined a large Medicare database, spanning 10 years of claims, and found that men were more likely than women to undergo either type of keratoplasty and that White patients were more likely than others to under­go PK but not EK. The odds of receiv­ing PK were higher for patients with concurrent diabetic retinopathy (DR) or glaucoma.

    The recent study was retrospec­tive in nature and included Medicare beneficiaries (≥65 years) who received an FECD diagnosis from 2011 through 2019 and had not been treated previ­ously for the disease. To determine de­mographic and medical factors associ­ated with EK and PK, the investigators used a multivariate logistic regression model that included age, race/ethnicity, sex, geographic location, comorbidities, surgery history, and socioeconomic status. Kaplan-Meier survival curves were generated to establish the rate of EK after cataract and various types of ocular surgery, including complex and other anterior segment procedures.

    Among the relevant Medicare population (N = 719,066), 31,372 (4.4%) had EK and 2,426 (.3%) had PK. According to multivariable analysis, female sex lowered the likelihood of EK and PK (adjusted OR [aOR], .83 and .84, respectively). Factors that raised the odds of either EK or PK were Western U.S. residence versus Southern resi­dence (aOR, 1.33 and 1.25, respective­ly) and history of complex or other an­terior segment surgery (aOR, 1.62 and 5.52, respectively). Relative to White patients, Blacks (aOR, 0.76), Asians and Pacific Islanders (aOR, 0.54), and Hispanics/Latinos (aOR, 0.62) were less likely to have EK and more likely to have PK (aOR, 1.32, 1.46, and 1.62, respectively). One year after cataract surgery, the overall probability of EK was 1.3%; by eight years, it increased to 2.3%. Among patients with complex or other surgery of the anterior segment, the EK rate was 3.3% at one year and 5.6% at eight years. Comorbidities that reduced EK likelihood were DR, age-related macular degeneration, mac­ular hole, and epiretinal membrane, likely due to the low potential for visual improvement, said the authors. PK was more common in patients with comor­bid DR or glaucoma.

    Although complex ocular anatomy may be a key driver for PK, a link to race and ethnicity persists. Findings of this study “may be useful when coun­seling patients about rates of EK after cataract or complex surgeries,” said the authors, and “may inform future efforts to increase diversity in clinical trial recruitment for FECD.”

    The original article can be found here.