Evaluation of Phacoemulsification Cataract Surgery Outcomes After Penetrating Keratoplasty

Abstract

BACKGROUND: Cataract is one of the reasons which causes impaired visual acuity (VA) of the eyes after penetrating keratoplasy (PK), which can be treated by cataract surgery after PK or triple procedure. Cataract surgery after PK has advantages that parameters of the eyes such as axial length, anterior chamber depth (ACD) as well as corneal curvature are stabilized after removing all sutures postoperatively, and intraocular lens (IOL) power can be calculated correctly. Therefore, postoperative VA will be improved significantly. In Vietnam, there have not been any study about cataract surgery after PK, therefore we conduct this research.
 AIM: To evaluate the outcomes of phacoemulsification cataract surgery following primary PK.
 METHODS: Non-randomized controlled intervention study. Ninteen eyes (19 patients) that underwent phacoemulsification plus IOL insertion after initial PK in Cornea department, Vietnam National Institute of Ophthalmology, from December 2013 to September 2014.
 RESULTS: All patients presented with reduced VA, including 17 eyes (89.9%) with VA ≤ 20/200, mean astigmatism was 7.9 ± 1.0 D. Clear corneal grafts in 16 eyes while corneal opacity was seen in 3 eyes. All eyes with cataract were diagnosed from grade 2. After cataract surgery, improved VA > 20/200 was achieved in 72.22% of cases. There was a markable reduce of postoperative astigmatism with 1,8 ± 0.8 D (p < 0.05). However, the immunologic graft reaction was presented in one eye, and two edematous corneas also reported after cataract surgery. After treatment, there was one cornea achieved its clarity.
 CONCLUSION: Phacoemulsification cataract surgery following initial PK showed good outcomes with improved postoperative VA, reduced astigmatism, and the ultimate graft survival rate was high.

Overview of visual acuity improvement in postoperative cataract patients using a monofocal lens and phacoemulsification techniques

“…In addition, other studies observed a decline in visual acuity in the majority of operated patients (89.9%) with visual acuity of ≤ 20/200 and moderate cataracts. This decline could be attributed to an immunologic graft reaction and edematous cornea (Cung et al, 2019), as well as automated refraction and corneal swelling (De Juan et al, 2013).…”

Long-Term Results and Refractive Error After Cataract Surgery With a Scleral Incision in Eyes With Deep Anterior Lamellar Keratoplasty

“…Other studies also used the SRK-T formula and corneal topography data and targeted a myopic postoperative spherical equivalent. 18,19 Preoperatively, we used the SRK-T formula with the mean keratometry provided by the specular corneal topographer and either B-scan or IOLMaster axial length (according to the measurement precision) to calculate the IOL power. A study evaluating IOL power calculation for the triple procedure (PK combined with cataract surgery) did not find significant differences in the mean absolute postoperative refractive error between the SRK-T, Holladay 1, and Hoffer Q formulas.…”

Peculiarities of Intraocular Lens Power Calculation During Keratoplasty (With Triple and Sequential Procedure)

“…При исследовании параметров роговицы большинством авторов рекомендуется заблаговременно снять роговичные швы, фиксирующие трансплантат, так как значения кератометрии, включающиеся в расчет ИОЛ, могут значительно измениться при интраоперационном или послеоперационном удалении шовного материала; при этом изменение рефракции в результате снятия шва может значительно снизить некоррегированную остроту зрения, полученную после имплантации ИОЛ. Поэтому, если возможно, следует дождаться полного снятия швов и последующей стабилизации кривизны роговицы после CКП c целью обеспечения стабильного рефракционного результата[7,14,15]. зависящих от оператора, которых нет при оптическом методе[17,18].…”