Objective: To study the indication and incision of phacoemulsification and intraocular lens (IOL) implantation after high-risk penetrating keratoplasty (PKP) and to evaluate the clinical results.
Methods: Twenty-six eyes of 25 patients who underwent high-risk PKP were treated with phacoemulsification and IOL implantation. The high-risk reasons included chemical burn of cornea, severe infective corneal perforation, total keratoplasty, diameter of the corneal graft larger than 8.5 mm, secondary keratoplasty and PKP combined with cataract extraction and anterior segment vitrectomy. Systemic and local steroid administration was given and surgical indication and incision were chosen according to the condition of the eyes. The mean interval time between PKP and IOL implantation was 11 months. Visual acuity, refractive status, central corneal endothelial cell density before and after IOL implantation (3 months) and allograft rejection were recorded. The mean follow-up after IOL placement was 17 months.
Results: Uncorrected visual acuity was 50/100 or better in 7 (27%) eyes and corrected visual acuity was 50/100 or better in 12 (46%) eyes. Fourteen (54%) eyes had refractive errors within 2 diopters. The mean refractive cylinders before and after IOL implantation were 5.70 D and 4.70 D, respectively (paired t test, t = 1.471, P = 0.154). The endothelial cell density before and after IOL implantation was 1883 cells/mm(2) and 1760 cells/mm(2), respectively (t = 1.934, P = 0.065) and the rate of endothelial cell loss was 6.5%. Only one graft rejection (4%) occurred 7 months after IOL implantation (anterior chamber IOL).
Conclusion: It is safe and effective to perform phacoemulsification and IOL implantation after high-risk PKP when paying attention to the perioperative treatment and selecting the surgical indication and the position of the incision.