From the Icahn School of Medicine at Mount Sinai, Department of Ophthalmology (G.L., A.S., J.K., S.A.), New York, New York, USA.
From the Icahn School of Medicine at Mount Sinai, Department of Ophthalmology (G.L., A.S., J.K., S.A.), New York, New York, USA.
Am J Ophthalmol. 2024 Oct;266:182-189. doi: 10.1016/j.ajo.2024.05.026. Epub 2024 May 25.
To identify risk factors associated with the development of corneal edema (CE) and the need for corneal transplantation following cataract surgery.
Retrospective cohort study.
Nation-wide sample of Medicare beneficiaries from 2011-2015.
Medicare beneficiaries aged over 65 years who received cataract surgery between 2011-2014 with at least 1 year of continuous follow-up. Data was retrieved from the Denominator and Physician Supplier Part B file from the Center for Medicare and Medicaid Services.
MAIN OUTCOME(S) AND MEASURE(S): The main outcome was the association between demographic characteristics (e.g., age, sex, race/ethnicity) and systemic factors including diabetes status, hypertension, and tobacco use on the incidence of CE and the subsequent need for corneal transplantation following cataract surgery.
Among 187,746 beneficiaries, 67,734 had diabetes and 120,012 did not. Beneficiaries with diabetes were more likely to develop CE compared to those without (Odds ratio [OR] 1.19, 95% Confidence Interval [CI] [1.02-1.40]). Compared to those aged 65-74, beneficiaries aged 75-84 and over 85 were more likely to develop CE (OR 1.29 [1.09-1.52]) and OR 1.96 [1.55-2.46], respectively). Asian (OR 2.42 [1.66-3.40]), Hispanic (OR 2.60 [1.73-3.74]), and North American Native (OR 3.59 [1.78-6.39]) race was associated with increased likelihood of developing CE. North American Native beneficiaries had higher risk of requiring corneal transplantation compared to White beneficiaries (OR 9.30 [2.26-25.31]). Female sex decreased likelihood of requiring corneal transplantation post-operatively (OR 0.56 [0.36-0.87]). Amongst those with diabetes, the presence of proliferative diabetic retinopathy increased the likelihood of developing CE (OR 1.94 [1.05-3.39]).
Older age, diabetes, and non-White race elevate the risk of CE following cataract surgery, with race incurring the highest risk. Further research is needed to understand the factors underlying the significantly increased risk of CE in racial and ethnic minorities within the United States.
确定与白内障手术后角膜水肿（CE）发展和角膜移植需求相关的风险因素。
回顾性队列研究。
来自 2011-2015 年医疗保险受益人的全国性样本。
2011-2014 年间接受白内障手术且至少有 1 年连续随访的年龄在 65 岁以上的医疗保险受益人。数据取自医疗保险和医疗补助服务中心的分母和医师供应商 B 部分文件。
主要结局是白内障手术后，人口统计学特征（如年龄、性别、种族/民族）和包括糖尿病状况、高血压和吸烟在内的全身因素与 CE 发生率以及随后的角膜移植需求之间的关联。
在 187746 名受益人中，67734 人患有糖尿病，120012 人没有。与无糖尿病者相比，患有糖尿病者更有可能发生 CE（优势比 [OR] 1.19，95%置信区间 [CI] [1.02-1.40]）。与 65-74 岁的人群相比，75-84 岁和 85 岁以上的人群更有可能发生 CE（OR 1.29 [1.09-1.52]和 OR 1.96 [1.55-2.46]）。亚洲人（OR 2.42 [1.66-3.40]）、西班牙裔（OR 2.60 [1.73-3.74]）和北美原住民（OR 3.59 [1.78-6.39]）的种族与发生 CE 的可能性增加有关。与白人受益人相比，北美原住民受益人的角膜移植需求风险更高（OR 9.30 [2.26-25.31]）。女性性别降低了术后角膜移植的可能性（OR 0.56 [0.36-0.87]）。在患有糖尿病的人群中，增殖性糖尿病视网膜病变的存在增加了发生 CE 的可能性（OR 1.94 [1.05-3.39]）。
年龄较大、患有糖尿病和非白人种族会增加白内障手术后发生 CE 的风险，其中种族风险最高。需要进一步研究以了解美国少数民族中 CE 风险显著增加的背后因素。
