Dorairaj, Syril

Abstract Introduction Cystoid macular edema (CME) is a recognized complication associated with penetrating keratoplasty (PK) and Endothelial Keratoplasty (EK). The purpose of this study was to determine the incidence of acute CME within the first 6 months after PK, Descemet stripping automated EK, or Descemet’s membrane EK. Methods A retrospective cohort analysis of the TriNetX United States collaborative database was conducted. Patients with a diagnosis of Fuchs dystrophy or keratoconus who underwent PK or EK between January 1, 2004 and August 30, 2024 were included. Those with a history of uveitis, retinal vascular occlusion, diabetic macular edema, or prior vitrectomy were excluded. Outcomes and diagnoses were defined using current procedural terminology and International Classification of Diseases, Tenth edition (ICD-10) codes. Cohorts were stratified based on a history of prior PK or EK with >6 months follow-up. Propensity score matching was performed on both cohorts to control for age at index, sex, race, ethnicity, and the diagnosis of Fuchs dystrophy and keratoconus. The incidence of acute CME during a 6-month postoperative follow-up period was assessed. Odds ratios were calculated between cohorts. Results A total of 2516 eyes were included in the study (PK: 1258; EK: 1258). At six months postoperatively, the incidence of acute CME in the EK cohort (46 of 1258) was significantly higher than in the PK cohort (20 of 1258) (P = 0.0012) (OR 0.426, 95% confidence interval 0.25–0.72). Conclusions Our findings suggest that the incidence of acute CME is higher in patients undergoing EK compared to PK.