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.