The impact of corneal guttata on the results of cataract surgery

Purpose: To study the impact of corneal guttata on postoperative visual acuity and patients' self-assessed visual function after cataract surgery. Setting: Patient data from 49 Swedish cataract surgery units. Design: Retrospective cross-sectional register-based study. Methods: Data from patients who had cataract surgery from 2010 to 2017 and completed the Catquest-9SF questionnaire were obtained from the Swedish National Cataract Register. Logistic proportional odds regression was used to model the impact of corneal guttata on the visual acuity and self-assessed visual function. Adjustments were made for age, sex, ocular comorbidities, days to follow-up, preoperative corrected distance visual acuity (CDVA) and preoperative Rasch person score. The main outcome measures were postoperative CDVA and Rasch person score calculated from the Catquest-9SF questionnaire. Results: The study comprised data from 33 741 patients. Cataract surgery greatly improved CDVA and self-assessed visual function in patients both with and without corneal guttata. Still, corneal guttata was significantly associated with a poorer visual acuity and a worse self-assessed visual function after cataract surgery. The negative effect of corneal guttata on visual acuity was most prominent during the first 3 weeks postoperatively, but it persisted at least 3 months postoperatively. Conclusions: Patients with corneal guttata benefit substantially from cataract surgery but have an additional risk for inferior results compared with patients without corneal guttata. These findings could serve as valuable tools in clinical practice, in particular, when deciding to perform cataract surgery and how to inform the patient about surgical benefits and risks. (C) 2019 The Authors. Published by Elsevier Inc. on behalf of ASCRS and ESCRS.