Efficacy and safety of cataract surgery following deep anterior lamellar keratoplasty and penetrating keratoplasty: an age and disease matched case control study

Session Details

Session Title: Cornea - Surgical III

Session Date/Time: Sunday 06/09/2015 | 14:15-16:15

Paper Time: 15:05

Venue: Room 16

First Author: : S.Shimazaki-Den JAPAN

Co Author(s): :    J. Shimazaki                    

Abstract Details

Purpose:

In order to investigate the efficacy and safety of cataract surgery following deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP), we conducted an age- and disease-matched retrospective case-control study.

Setting:

Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan.

Methods:

Thirty eyes each that underwent cataract surgery by phacoemulsification and intraocular lens insertion following DALK or PKP were studied. Causative diseases in each group were lattice dystrophy (2 eyes), keratoconus (2 eyes) or corneal scar (26 eyes). Graft clarity, best spectacle-corrected visual acuity (BSCVA), spherical equivalence (SE), refractive error from the expected values (RE) and endothelial cell density (ECD) were compared between two groups at 1, 3, 6 and 12 months following cataract surgery. There were no significant differences in these parameters before the surgery. Mean follow-up periods were 26 and 30 months in the DALK and PKP groups, respectively.

Results:

While all eyes had successful cataract surgery in DALK group, 5 eyes in PKP group were complicated with posterior capsule rupture. Grafts clarity rates were 90.0 and 86.7% in DALK and PKP groups at final follow-up, respectively (P>0.05). BSCVA was significantly improved in both groups following surgery (P<0.001). REs were -0.5±2.4D and -0.4±1.9D at 1 month after surgery in DALK and PKP group, respectively, and were stable thereafter. Decreases in ECD at 12 months following surgery were significantly more in PKP group compared with DALK group (8.7±21.7 % vs. 26.3±27.8 %, P=0.0432).

Conclusions:

Cataract surgery was successfully performed in both DALK and PKP groups. Visual and refractive outcomes were excellent in both groups. ECD was decreased more in PKP group following cataract surgery indicating that donor endothelia may be more susceptible to surgical trauma and postoperative inflammation. In cases of combined cataract and corneal pathology without endothelial involvement, sequential approach of DALK-cataract surgery may be beneficial for avoiding endothelial damage.

Financial Interest:

NONE