Case series of deep anterior lamellar keratoplasty combined with phacoemulsification and intra-ocular lens implantation – a modified triple procedure

Abstract

Background: Patients presenting with corneal pathology and cataract present a surgical challenge to the operating surgeon. Some Ophthalmologists prefer to perform combined keratoplasty and cataract surgery simultaneously, while some prefer to perform sequentially. Purpose: To describe performing deep anterior lamellar keratoplasty and phacoemulsification surgery on two patients with corneal opacity and cataract. Setting: National Eye Hospital, Colombo Methodology: We report two patients who underwent Deep Anterior Lamellar Keratoplasty (DALK) and cataract surgery.The first patient was a 66-year male patient. He had hand movement vision in both eyes. The right eye had diffuse corneal haze (corneal depositions) and a white mature cataract. The left eye also had corneal haze and a mature cataract. The fundi could not be visualized but the B scan showed an attached retina. The intra-ocular pressure of both eyes were normal.The second patient was a 54-year female with right eye 6/60 due to diffuse corneal opacity (old interstitial keratitis) and mature cataract in the right eye. The left eye had a clear cornea and had IOL and the Best corrected visual acuity was 6/6. The fundus of the right eye was poorly visualized, but the B scan showed attached retina and the Intra-ocular pressure was normal.Surgery was performed in the sequence of lamellar keratoplasty followed by phacoemulsification and Intraocular lens implantation and finally completion of corneal deep anterior lamellar keratoplasty with manual dissection. Both patients achieved good visual outcomes over 6 months postoperatively. Conclusion: Corneal pathology with cataracts can be operated on as a simultaneous surgery. However, preoperative planning for surgical surprises and the suitable sequalae of surgical steps, with proper IOL power calculation leads to good visual outcomes.