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The Ocular Surface Following Cataract Surgery in Ocular Graft-Versus-Host Disease: A Multicenter National Analysis
Jainam Shah1, Sachin Pathuri1, Karl Golnik2
1Albert Einstein College of Medicine, Bronx, NY.
Purpose:
To evaluate postoperative ocular surface complications following cataract surgery in patients with ocular graft-versus-host disease (oGVHD).
Methods:
A retrospective cohort study was conducted using deidentified patient data from a multicenter federated electronic health record network from 2013 to 2025. Cataract surgery patients were categorized into 3 cohorts: oGVHD (n = 1483), hematopoietic stem cell transplantation (HSCT) recipients with graft-versus-host disease (GVHD) without ocular involvement (n = 1558), and controls without prior HSCT or GVHD (n = 693,399). After 1:1 propensity score matching, postoperative complications, vision-threatening corneal events (VTCE), and treatment escalation were compared between groups using Cox proportional hazards models to estimate hazard ratios (HRs). Associations between preoperative ocular surface activity timing and postoperative risk were assessed. Preoperative ocular surface optimization was evaluated in an exploratory analysis.
Results:
oGVHD was associated with increased VTCE risk compared with controls (HR: 1.87; P < 0.001) and HSCT recipients with GVHD but no ocular involvement (HR: 1.36; P = 0.007). oGVHD was also associated with greater escalation of ocular surface management, including medical therapy, amniotic membrane grafting, and tarsorrhaphy (all P < 0.05), with differences persisting through 1 year of follow-up. Postoperative risk increased as preoperative ocular surface activity occurred closer to surgery, with the highest VTCE risk observed when activity occurred within 30 days before surgery (HR: 3.78; P < 0.001). Preoperative ocular surface optimization was associated with lower VTCE risk (HR: 0.56; P = 0.042).
Conclusions:
oGVHD is associated with increased postoperative ocular surface complications and therapeutic escalation after cataract surgery, with risk rising as preoperative disease activity approaches surgery. Preoperative ocular surface optimization may mitigate risk, supporting perioperative management.
