Posters

Cataract surgery and penetrating keratoplasty: sequential vs combined procedure

Poster Details

First Author: S.Chatterjee INDIA

Co Author(s):    D. Agrawal                    

Abstract Details

Purpose:

In developing countries penetrating keratoplasty(PK) remains surgery of choice as corneal scars and infectious keratitis constitute the bulk of indications. When significant cataract is present, cataract surgery with intra-ocular lens implantation(IOL) is combined with PK in the same sitting - triple procedure (TP). However sequential surgery (SS), where cataract surgery with IOL is done following PK is often required because a clear lens at the time of initial surgery may develop cataract later on. Both the surgeries have their challenges. The purpose of this paper is to compare visual outcome and complication rate between SS and TP.

Setting:

Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India

Methods:

Retrospective review of medical records of all consecutive patients undergoing TP or SS from 2005 to 2016 at a single center. Patients with less than 1year follow-up and cataract surgery combined with PK for microbial keratitis were excluded. Outcome variables included best corrected distant visual acuity (CDVA) measured with logMAR visual acuity charts, manifest spherical equivalent (MSE), spherical and cylinder power (SP and CP), intra- and post-operative complications. Statistical analysis: paired and unpaired student t test, z test for proportions with SPSS for Windows Ver 16.0. P value less than 0.05 was considered to be statistically significant.

Results:

Final analysis included 24 SS and 73 TP. Mean follow-up was 27.2 ± 28.6(12- 110.5) in SS and 52.6 ± 45.9 (12-240) months in TP. In SS, pre-operative CDVA improved from 1.45±0.7 to 0.31± 0.31 (p<0.0011) after surgery but reduced to 0.72±0.81(p=0.009) at last follow-up. In TP, CDVA improved from 2.11±0.55 pre-operatively to 0.74±0.61 (p<0.0001) post-operatively but reduced to 1.10±0.89 (p<0.001) at last follow-up. CDVA was better (p<0.0016) in the SS (20/40) compared to TP (20/100). MSE, SP, CP not significantly different between groups. Graft infiltrate and failure twice more in TP group.

Conclusions:

Both the groups achieved significant CDVA after surgery although by last follow-up visit it had reduced significantly due to occurrence of graft infiltrate and graft failure. There was no significant difference in residual refractive error between the groups. Cataracts that are judged not to affect vision, or not removed during therapeutic PK may be removed later without deleterious effect.

Financial Disclosure:

None