The incidence of major postoperative complications, including endophthalmitis, retinal detachment and choroidal hemorrhage, following endothelial keratoplasty (EK) procedures is low, a recent study suggests. Despite this finding, researchers noted that a high proportion of eyes undergoing EK eventually require glaucoma surgery and experience graft-related complications.

This retrospective cohort study included 71,040 patients (29% had pre-existing glaucoma) who underwent a total of 94,829 EK procedures. A team evaluated the occurrence of major postoperative complications following EK surgery, time-to-event data for glaucoma surgery and the occurrence of graft complications.

The investigators reported overall 90-day cumulative incidences of postoperative endophthalmitis and choroidal hemorrhage following EK of 0.03% and 0.05%, respectively. They noted that the overall one-year cumulative incidences of retinal detachment and related surgery, infectious keratitis and cystoid macular edema were 1.0%, 0.8% and 4.1%, respectively.

They found that approximately 7.6%, 12.2% and 13.8% of all eyes needed glaucoma surgery at one, five and eight years of follow-up, respectively. They added that the probabilities of glaucoma surgery among patients with and without pre-existing glaucoma were 29% vs. 8%, respectively, at eight years. The chance of developing graft complications was 13%, 23.2% and 27.1% at one, five and eight years of follow-up.

On average, they concluded that patients undergoing EK procedures for a prior failed graft had the highest rate of complications, while those with Fuch’s corneal endothelial dystrophy had the lowest.