Cataract surgery after deep anterior lamellar keratoplasty and penetrating keratoplasty in age- and disease-matched eyes

Abstract

Purpose: To assess the efficacy and safety of cataract surgery after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP).

Setting: Tokyo Dental College Ichikawa General Hospital, Chiba, Japan.

Design: Retrospective case series.

Methods: Age-matched and disease-matched eyes that had phacoemulsification and intraocular lens insertion after DALK or PKP were studied. Graft clarity was assessed at the final follow-up. The difference in the endothelial cell density (ECD), corrected distance visual acuity (CDVA), spherical equivalence, and refractive error between the expected values and values 1, 3, 6, and 12 months after cataract surgery were compared between the 2 groups.

Results: Indications for keratoplasty were corneal stromal scar (22 eyes), lattice dystrophy (2 eyes), keratoconus (2 eyes), and postherpetic keratitis (4 eyes). All 30 eyes in each group had successful cataract surgery after keratoplasty. Graft clarity rates were 90.0% and 80.0% in the DALK group and PKP group, respectively (P = .47). The decrease in ECD at 12 months was significantly greater in the PKP group than in the DALK group (8.7% [SD] ± 21.7% versus 26.3% ± 27.8%) (P = .043). The CDVA was significantly improved in both groups. At 1 month, the mean refractive error was -0.5 diopter (D) ± 2.4 (SD) in the DALK and -0.4 ± 1.9 D in the PKP groups and remained stable thereafter.

Conclusions: Cataract surgery was successfully performed in eyes that had DALK or PKP, providing excellent visual and refractive outcomes. In cases of combined cataract and corneal pathology, and in the absence of endothelial involvement, DALK followed by cataract surgery might cause less endothelial damage.