This registry-based cohort study from Sweden utilised data from the Swedish National Cataract Registry and the Swedish Cornea Transplant Registry. Patients who underwent phacoemulsification with a posterior intraocular lens between 2010 and 2012 numbered 192,476. Of these cases, 288 underwent corneal transplantation due to endothelial failure between 2010 and September 2017. The authors investigated the effects of posterior capsule rupture (PCR) and dense cataract and whether corneal guttata presented an increased risk for needing a corneal transplant. Trypan blue capsular staining (TB) was used as a pseudomarker for dense cataract. The overall incidence rate of corneal transplantation after phacoemulsification in the whole cohort was 2.8 per 10,000-person years compared to 10.42 per 10,000-person years with TB, 8.93 per 10,000-person years with PCR and 24.65 per 10,000-person years when both TB and PCR occurred. The adjusted relative risk (RR) for corneal transplantation after phacoemulsification with TB was found to be 3.83 and was lower for PCR at 3.46. When both TB and PCR occurred, the RR was much higher at 9.69. The authors show that dense cataract and PCR at phacoemulsification, both separately and the combination of them, were associated with a higher risk for future corneal transplantation independent of corneal guttata and other adjusted variables. The visual acuity and patient satisfaction results were quite limited but showed a trend towards inferior results in PCR and dense cataract. Limitations included not being able to investigate the experience of the surgeons involved and whether patients underwent secondary procedures, such as vitrectomy or lens implantation, after their complicated cataract operation. Also, patients with bullous keratopathy or Fuchs endothelial corneal dystrophy without performed corneal transplantation were not captured.
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