The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion

Abstract

Purpose The aim of this study was to investigate the visual and refractive outcome of combined penetrating keratoplasty, cataract extraction, and intraocular lens insertion (triple procedure) compared with cataract surgery following penetrating keratoplasty (sequential surgery). Methods Retrospective cohort study of 1256 first penetrating keratoplasty for Fuchs' dystrophy performed between April 1999 and December 2005. In all, 1202 triple and 54 sequential procedures were reviewed. At 1 year, refractive outcomes were available for 499 triple procedure and 26 sequential surgery eyes. At 2 years, data were available for 264 triple procedure and 10 sequential surgery eyes. At 1 and 2 years postoperatively, graft survival, best-corrected visual acuity (BCVA), spherical equivalent, and cylindrical error were recorded. v 2 -Tests were used to compare visual outcomes between the two groups.Results At 1 year after triple procedure surgery, 61% of eyes attained BCVA of X6/12, with 47% of eyes within±2 D of emmetropia. After sequential surgery, 59% achieved BCVA of X6/12 with 67% of eyes within±2 D of emmetropia ( ¼ 0.05). Mean spherical equivalent (MSE) at 1 and 2 years after triple procedure was þ 1.20 D (SD 5.45) and þ 0.15 D (SD 3.58), respectively. MSE following sequential surgery at 1 and 2 years was þ 0.08 D (SD 3.06) and À1.50 D (SD 3.14), respectively. Mean refractive cylinder after combined surgery was þ 4.16 D (SD 5.11) and þ 3.91 D (SD 2.79) at 1 and 2 years, respectively, compared with þ 3.65 D (SD 2.24) and þ 3.70 D (SD 2.06) after sequential surgery. In all, 29% of triple procedure and 27% sequential surgery eyes had an astigmatic error X5.0 D after 1 year (P ¼ 0.64), which increased to 34 and 30%, respectively, by the second year. The 5-year graft survival was 85% in both groups. There were no differences in graft survival, visual or refractive outcomes between triple procedure, and sequential surgery techniques. Conclusions This analysis provided no evidence of improved visual or refractive outcome after sequential surgery compared with triple procedure.

Simultaneous Phacoemulsification and Graft Refractive Surgery in Penetrating Keratoplasty Eyes

“…Previous studies have shown that 44 to 64% of the patients develop cataracts within 5 years of penetrating keratoplasty, which is significantly higher than the rate in the general population at the same age [6, 14–17]. This higher incidence of cataract formation after PKP can be attributed to intraoperative lens trauma, postoperative inflammation, and topical steroid use.…”

“…This higher incidence of cataract formation after PKP can be attributed to intraoperative lens trauma, postoperative inflammation, and topical steroid use. Cataract developing after keratoplasty can be managed safely using advanced phacoemulsification techniques and IOL implantation, with no increased risk of endothelial cell loss, endothelial graft rejection, or failure [15–17]. …”

New endothelial keratoplasty, phacoemulsification, and intraocular lens implantation triple procedure: Comparison with conventional triple procedure

“…Conventional triple procedures have excellent anatomic success in terms of graft clarity and survival but only moderately good functional results. [21][22][23] Nguyen et al 21 evaluated the visual and refractive results in a 1-year follow-up of 499 eyes that had the conventional triple procedure. The authors report that 61% of patients had a postoperative CDVA of 20/40 or better; however, 47% had a refractive error of less than 2.00 D shift from the target refraction of emmetropia.…”

Approaching Cataract Surgery in Patients With Fuchs' Endothelial Dystrophy

“…The significant attrition and uneven group sizes limits the utility of the study, but overall the study suggests that in elderly patients with coexisting cataract and Fuchs' endothelial dystrophy, the triple procedure is advantageous given the similar outcome measures and increased visual recovery from a single surgical experience. 31 Another retrospective study examining similar outcome measures of vision and refraction post-PK versus posttriple in Fuchs' patients was carried out with somewhat longer follow-up. Das et al 32 found that there was no statistically significant difference in visual acuity or refraction between the 2 groups after a mean follow-up of 2.9 years.…”