Cataract surgery in patients with PKP

Session Details

Session Title: Cataract: Special Cases

Session Date/Time: Monday 15/09/2014 | 17:00-18:30

Paper Time: 17:24

Venue: Boulevard B

First Author: : P.Vassileva BULGARIA

Co Author(s): :    Y. Kirilova   I. Shandurkov           

Abstract Details

Purpose:

present our surgical approach in patients with PKP and associated cataract.

Setting:

All consecutive phakic patients with PKP operated for the period of 6 years (Jan 2007- Dec 2012) in University Eye Hospital “Prof. Pashev” with follow up of 15 months to 7 years.

Methods:

Interventional study with different surgical approach depending on lens status at PKP was undertaken (combined/triple procedure or consecutive surgery for cataract). Standard surgical technique with vacuum trepans for PKP was performed with suture removal in 24 +/- 2 months.

Results:

Included 127 phakic patients, mean age 47 (range 18-64). Indication for corneal transplantation are keratoconus n=51 (40%), corneal dystrophies n=33 (26%), leucoma n=25 (20%), graft failure n=8 (6%), corneal perforation n=5 (4%), pellucid degeneration n=3 (2%), corneal abscess n=2 (2%). Cataract was diagnosed at PKP in 15 patients (12%). When there is enough visibility phacoemulsification of cataract followed by PKP was performed. In 10 patients open sky cataract surgery (triple procedure) was undertaken. Formation/progression of cataract post PKP was diagnosed in 42 patients (33%). Phacoemulsification in early postoperative period (before suture removal) for intumescent cataract with increased IOP was done in 10 patients (8%). Planned phacoemulsification about 3 month after suture removal was performed in 32 patients (25%). Clear lens/ no cataract formation at last follow up was observed in 18 patients (14%).

Conclusions:

Considerable debate consists on surgical approach to surgical in patients with PKP associated with lenses opacities. There are strong arguments for triple procedure even for initial cataract at PKP mostly for older patients. Consecutive phacoemulsification post suture removal assures more accurate IOL calculation and better visual results. Our experience demonstrated excellent outcome after consecutive phacoemulsification in patients with corneal transplantation. Customized surgical technique and endothelial protection assure full restoration of vision.

Financial Interest:

NONE