Rate and risk factors for cataract formation and extraction after Descemet stripping endothelial keratoplasty

PURPOSE: To assess the rate and risk factors for cataract formation and extraction after Descemet stripping endothelial keratoplasty (DSEK). METHODS: An initial, consecutive series of 1050 primary DSEK procedures was reviewed to identify eyes that remained phakic. Only the first-treated eye of each patient was included; 60 eyes qualified. Rate and risk factors for subsequent cataract formation and extraction were assessed by multivariate proportional hazards modelling and survival analysis. RESULTS: Median patient age was 52 years (range: 32–69 years), and median graft diameter was 8.5 mm (range: 8–9 mm). Median follow-up was 32 months (range: 1–51 months). Cataract extraction was performed after DSEK in 22 eyes (37%) without complication and all grafts remained clear with median follow-up of 18 months (range: 1–44 months). Six eyes were regrafted; all underwent cataract extraction either simultaneously (n=4) or subsequently (n=2). At 1 and 3 years, respectively, the probability of cataract extraction was 0% and 7% in patients who were 50 years or younger at the time of DSEK (n=20) versus 31% and 55% in older patients (n=40), a statistically significant difference (p=0.0005). CONCLUSIONS: Rates of cataract formation and extraction after DSEK were significantly higher in patients over 50 years of age and substantially exceeded normal population rates.