Abstract
Purpose. To report outcomes of graft refractive surgery (GRS) along with clear-cornea phacoemulsification and intraocular lens (IOL) implantation in penetrating keratoplasty (PKP) eyes. Methods. Fourteen eyes of 13 patients who had received PKP underwent simultaneous GRS (relaxing incisions with or without counter-quadrant compression sutures) and clear-cornea phacoemulsification with IOL implantation. To calculate IOL power, preoperative keratometry readings and the SRK-T formula were used. Results. Mean patient age and follow-up period were 50.5 ± 14.4 years and 14.6 ± 7.1 months, respectively. A significant increase was observed in best spectacle-corrected visual acuity (from 0.55 ± 0.18 logMAR to 0.33 ± 0.18 logMAR, P = 0.001). There was a significant decrease in vector keratometric astigmatism by 6.22 D (P = 0.03). Spherical equivalent refraction was reduced from −3.31 ± 3.96 D to −1.69 ± 2.38 D (P = 0.02) which did not significantly differ from the target refraction (−0.76 ± 0.14 D, P = 0.20). No complications developed and all the grafts remained clear at the final examination. Conclusion. Simultaneous phacoemulsification and GRS is a safe and effective method to address post-PKP astigmatism and lens opacity. IOL power can be calculated from preoperative keratometry readings with an acceptable accuracy. However, patients should be informed about the possibility of high refractive errors postoperatively.
Highlights
The most common complication of penetrating keratoplasty (PKP) is astigmatism [1]
It is sometimes combined with other interventions such as cataract extraction and posterior chamber intraocular lens (IOL) implantation to simultaneously address lens opacity and high corneal graft astigmatism
For IOL power calculation, preoperative keratometry readings measured by the manual keratometer were considered, and postoperative refraction was targeted at −0.76 ± 0.14 D, on average
Summary
The most common complication of penetrating keratoplasty (PKP) is astigmatism [1]. Several studies indicate that 15– 31% of the patients who undergo PKP may develop postoperative astigmatism greater than 5 diopters (D) [2,3,4]. In the majority of cases, GRS is the only procedure performed at a single time. It is sometimes combined with other interventions such as cataract extraction and posterior chamber intraocular lens (IOL) implantation to simultaneously address lens opacity and high corneal graft astigmatism. The former develops after corneal transplantation at a higher rate as compared to normal populations due to intraoperative lens trauma, postoperative inflammation, and topical steroid use [6]
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