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Secondary Intraocular Lens Implantation After Simultaneous Penetrating Keratoplasty and Cataract Extraction for Coexisting Corneal and Lens Opacities

Solaiman, Kamal A. M., MD; El-Haig, Wael M., MD; Bor'i, Ashraf, MD; Khalil, Ahmad S., MD; Awad, Ahmed M. B., MD; Al-Bialy, Hani A., MD; Ibrahim, Basem M., MD

doi: 10.1097/ICO.0000000000001861
Clinical Science

Purpose: To report the results of a new approach to the 2-stage surgical management of coexisting visually significant corneal opacities and cataract.

Methods: A retrospective analysis of eyes with corneal opacities and cataract that were surgically treated with simultaneous penetrating keratoplasty and cataract surgery, followed by secondary intraocular lens (IOL) implantation after removal of corneal sutures, was conducted. The parameters used for assessment were the following: mean percentage of graft endothelial cell loss after IOL implantation, deviation of the postoperative mean spherical equivalent from the target refraction, and mean uncorrected distance visual acuity (UDVA).

Results: Twenty-nine eyes were included in the study. The mean baseline UDVA was 1.94 ± 0.46, and the mean baseline best-corrected distance visual acuity was 1.56 ± 0.42. The mean interval between the 2 surgical interventions was 13.3 ± 2.2 months. Just before secondary IOL implantation, the mean endothelial cell density was 2198 ± 311 cells. The mean percentage of corneal endothelial cell loss was 7.3% at 6 months after IOL implantation (P = 0.16). Before IOL implantation, the mean spherical equivalent was +11.75 ± 3.38 D. After IOL implantation, the mean spherical equivalent improved to −0.19 ± 0.93 D (P = 0.003) at 6 months. The mean UDVA improved to 0.34 ± 0.18 (P = 0.017), whereas the mean corrected distance visual acuity improved to 0.18 ± 0.29 at 6 months (P = 0.016). All grafted corneas maintained their clarity until the final follow-up visit.

Conclusions: Postponing IOL implantation some months after simultaneous penetrating keratoplasty and cataract extraction has a negligible effect on the corneal graft endothelium and achieves near postoperative target refraction with significant improvement in UDVA.

Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Correspondence: Kamal A. M. Solaiman, MD, Department of Ophthalmology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received June 14, 2018

Accepted November 29, 2018

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