Ocular Microbiology and Immunology Group
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2026 OMIG Abstract

POSTER PRESENTATION


Predictors of Corneal Transplantation in Patients with Corneal Ulcers

Anusha Tuli¹ and Sonal Tuli²

¹University of Miami; Miami, Florida; ²University of Florida, Gainesville, Florida

Purpose: To identify clinical and demographic characteristics that distinguish corneal ulcer patients who subsequently undergo corneal transplantation from those who do not, using a large multi-institutional real-world dataset.

Methods: Using the TriNetX US Collaborative Network, a federated electronic health record database spanning 70 U.S. health systems, adult patients (>18 years) with a diagnosis of corneal ulcer were identified and classified into two groups. Group A included those who underwent subsequent corneal transplantation and Group B included those who did not. Demographic data was compared between the groups. Then, propensity score matching was performed at a 1:1 ratio on age, sex, race, and ethnicity and the groups were compared across diagnoses, procedures, and medications, with standardized mean difference (SMD) used to identify variables meaningfully imbalanced between groups after matching. Variables with SMD > 0.1 were considered clinically significant predictors of transplant progression.

Results: Group A included 5660 patients and Group B included 102,511 patients. The group undergoing transplantation was significantly older (mean 59.2 vs. 48.9 years), and were more likely to be male, white, or Hispanic (all p<0.0001). After propensity score matching, there were 5,436 patients in each cohort. The strongest predictors of transplantation were prior keratoplasty (25.8% vs. 2.0%, p<0.0001), prior glaucoma procedures (11.8% vs. 2.3%, p<0.0001), antiglaucoma medication use (29.9% vs. 11.4%, p<0.0001), steroid use (48.8% vs. 36%, p<0.0001), antifungal use (0.9% vs 0.2%, p<0.0001), prior vitreoretinal surgery (10.5% vs. 3.7%, p<0.0001), and cataract surgery (12.0% vs. 4.8%, p<0.0001). Among infectious etiologies, herpes simplex infection (7.3% vs. 4.3%, p<0.0001), herpes zoster infection (3.9% vs. 3.0%, p<0.0001), and acanthamoeba (0.5% vs. 0.2%) were significantly more prevalent in the transplant group.

Conclusions: Older age and certain races were more likely to progress to corneal transplantation following corneal ulceration. Ocular conditions leading to compromised ocular surface or immunity, such as prior corneal transplantation, glaucoma, glaucoma surgery, and more unusual organisms such as herpes, fungus, or acanthamoeba, were more likely to need transplantation. These findings identify a profile of high-risk corneal ulcer patients who may benefit from early subspecialty referral, closer surveillance, and proactive surgical planning.