Abstract

DO.03.10

Cataract surgery in cases with penetrating keratoplasty

Vassileva P., Hergeldzieva T., Shandurkov I.
Specialized Eye Hospital “Pashev”, Sofia, Bulgaria

Objective: To study cataract formation in patients who have undergone penetrating keratoplasty, and to assess postoperative results after phacoemulsification (visual acuity and graft survival).
Methods: For the period of 4 years from September 2002 to September 2006 penetrating keratoplasty was performed on 87 phakic patients with mean age 47 years (range 18-79). Keratoconus was the commonest indication for surgery (n=49, 56.3%), followed by corneal dystrophy (n=10, 11.5%), leucoma (n=9, 10.3%), corneal perforation (n=7, 8.1%), graft failure (n=6, 7.0%), corneal abscess (n=3, 3.4%) and pellucid degeneration (n=3, 3.4%). Patients were followed for the period of 5 months to 4 years for the development of lens opacities. Phacoemulsification with implantation of foldable PC IOL was the preferred surgical technique in cases with cataract formation.
Results: Ten patients (11.5 %) had mild lens opacities before corneal transplantation and in 8 (9.2% of all patients) cataract progressed. 17 patients (19.5 %) without cataract before surgery developed lens opacities for the period of 7-36 months (average 16 months) after keratoplasty. Planned surgery was performed 3 months after suture removal for more precise IOL power calculation. Post-keratoplasthy astigmatism was in the range of 1.00- 3.50 D. Altogether 25 phacoemulsifications were performed on those patients during the studied period. Slight modifications in surgical technique were applied as needed according to the anterior segment status. No serious complications were registered during cataract surgery. Seventeen patients (68%) achieved visual acuity above 0.5. Final best corrected visual acuity was 0.8-1.0 in eight patients (32%). Only 1 patient developed graft complication – transient opacification close to the corneal tunnel. All corneal grafts remained clear after cataract surgery during the period of observation.
Conclusions: Development of cataract is a common complication after penetrating keratoplasty. Our results demonstrate excellent outcome after phacoemulsification in patients with corneal transplantation. Customized surgical technique and endothelial protection assure full restoration of vision.

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