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| ORIGINAL ARTICLE |
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| Year : 1991 | Volume
: 39
| Issue : 3 | Page : 102-104 |
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Keratoplasty and cataract extraction
Anita Panda, T Sanker Kumar
Cornea Service, Dr. R.P. Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi, India
Correspondence Address:
Anita Panda
Cornea Service, Dr. R.P. Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 1841879 
Fifty eyes were evaluated following penetrating keratoplasty and cataract extraction. Twenty five of them had intracapsular lens extraction while the remaining 25 had intercapsular method of extracapsular lens extraction. Both operative and post operative complications were more in group I. Visual outcome and graft clarity were also better in eyes of group II. Combined keratoplasty and intercapsular method of extracapsular lens extraction was recommended in eyes having both corneal and lenticular pathology.
How to cite this article:
Panda A, Kumar T S. Keratoplasty and cataract extraction. Indian J Ophthalmol 1991;39:102-4 |
| Introduction | |  |
In coexistence of corneal opacity and cataract it is yet to be decided whether keratoplasty along with lens extraction or keratoplasty alone at first sitting followed by lens removal will be preferred. In the literature on this while there are many advocates of keratoplasty and cataract extraction [1][2][3][4] other surgeons continue to favour separate procedures [5],[6]. The reported incidence of graft failure varies considerably with either procedure ranging from 22-69% for the combined procedure [1],[7],[8] and from 19-61% when lens extraction is done in a subsequent operation [9],[10].
The problems of extracapsular lens extraction in a combined procedure like keratoplasty and cataract extraction are much more enhanced than with simple lens extraction.
Extracapsular lens extraction for simple cataract is the modern surgery of the day, both for its reduced incidence of visually disabling complications like vitreous loss, corneal decompensation, cystoid macular oedema and for its necessity in posterior chamber intraocular lens implantation.
The purpose of this communication is to compare the final anatomical and functional success in these two groups of patients where keratoplasty was combined with either extracapsular or intracapsular lens extraction.
| Material and methods | | |
The material consists of penetrating keratoplasty with intracapsular cataract extraction done for corneal and lenticular pathology in twenty five eyes and compared with the same number of eyes having similar pathology where penetrating keratoplasty was performed along with extracapsular lens extraction. All the operations were performed by one surgeon. Only uncomplicated operative cases were selected for this study. The sizes of the graft varied from 7.1 mm to 8.1 mm. All the donor eyes were evaluated by specular microscopy. The cell counts of eyes used for both groups were identical.
The comparison between the two groups of cases was made on the basis of post-operative complications, graft clarity and visual acuity. Post-operatively all the cases had systemic antibiotics, corticosteroid and antiglaucoma therapy.
Lens extraction was performed by cryo. For extracapsular lens extraction intercapsular method of nucleus delivery and aspiration was carried out.
| Results | | |
The age group of the patients varied from 26-65 years. The aetiology of the patients were as shown in [Table - 1]. The various operative, early and late post operative complications are enumerated in [Table - 2][Table - 3][Table - 4]. [Table - 1][Table - 4] highlight the graft clarity and final visual acuity.
| Discussion | | |
Cataract extraction in a clear graft has been reported to result in clouding of the graft in 19-61% of cases [9][10][11][12][13][14]. However Stark and Maumenee reported 100% results following this procedure [6].
It has also been commented that despite the use of a scleral incision and meticulous care to avoid endothelial damage during lens extraction 20% of previously clear grafts have lost some of their transparency [2].
With the advance of modern microsurgical technique and the better scanning of donor material by specular microscopy the results of penetrating keratoplasty improved. Failure of a corneal graft following penetrating keratoplasty is usually the result of endothelial damage. This can result from various causes such as post operative vitreous touch to the back of cornea, severe iridocyclitis and secondary glaucoma.
Vitreous must be out of the anterior chamber and away from the wound. (2) Avoidance of post operative pupillary block which is again mainly due to vitreous bulge. These two factors are more likely to develop following intracapsular lens extraction than extracapsular lens extraction.
Between the two methods of lens extraction with keratoplasty Kaufman in 1972 had shown better results following intracapsular lens extraction method. Aspiration of cortical material in an open chamber specially in combined surgery is more difficult than simple extraction by limbal section. Aspiration by making a closed chamber by placement of donor tissue is hazardous to the donor endothelium, the same cannot be practised in presence of the opaque host cornea. Therefore, the procedure of intercapsular method of lens nucleus delivery and cortex aspiration was carried out in all the cases. More operative vitreous disturbance in intracapsular lens extractions leading to more post operative complications made us follow the intercapsular method of lens extraction.
The final outcome in the term of graft clarity of three plus or more was seen in 60% and 80% eyes of group I and II respectively. Similarly, the visual outcome 6/18 or more was seen in 69% of group I eyes and 64% improving to 72% following YAG laser capsulotomy in group II eyes. Considering our comparative data at the present time a combined penetrating keratoplasty and intercapsular lens extraction will be the method of choice if the patient requires both keratoplasty and cataract surgery irrespective of combined double or triple procedure.
| References | | |
| 1. | Katzin H.M., Melatzer J.E. Combined surgery for corneal transplantation and cataract extraction. Amer Jour. Ophth. 1966, 62:556, 560.  |
| 2. | Casey TA. The combined operation of cataract and corneal graft Ophth. Soc. U.K. 1969, 89:659-668. |
| 3. | Herbert E. Kaufman Combined keratoplasty and cataract extraction Amer. J. Ophth. 1974. 77:824-829. |
| 4. | Jaun J. Arentsen, Peter R. Laibson Penetrating Keratoplasty & Cataract, AMA Arch. Ophthalmol. 1978: 96:75-76. |
| 5. | J.A. Capells, Herbert E. Kaufman Prognosis of keratoplasty in phakic and aphakic patients Trans Ophth. Otolaryngology 1972: 76:1275-1283. |
| 6. | Walter J. Stark, A. Edward Maumenee Cataract extraction after successful penetratingkeratoplasty. Amer J. Ophth. 1973:75:751-754. |
| 7. | Boruchoff S.A. Combined graft and lens extraction. The second report on cataract surgery. Miami, Miami Education Press 1971, Page 281. |
| 8. | Stark W.J., Paton D. Maumenee A.E., Michelson PE. The result of 102 penetrating keratoplasties using 10-0 monofilament nylon suture. Ophth. Surg. 1972: 3.11.16. |
| 9. | Modre I. E Jt ' Aronson S.B. The corneal graft. A multiple variable analysis of the penetrating keratoplasty Amer. J. Ophth. 1971 72:205-212. |
| 10. | Fine M. Therapeutic keratoplasty in Fuch's dystrophy. Amer. J. Ophth. 1964: 57:371-378. |
| 11. | Paton R.T, Swartz G. Keratoplasty in Fuch's dystrophy Arch. Ophth. 1959 : 61:366. |
| 12. | Hughes W.F The treatment of corneal dystrophies by keratoplasty. Amer. Jour. Ophth. 1960: 56:1100. |
| 13. | Mohan M, Panda A, Chawdhary S. Penetrating Keratoplasty in Primary Fuch's dystrophy. Proceedings of Ind. J. Ophth. 1984: 32:394-398. |
| 14. | Lemp M.A., Prister R.R., Dohiman C.H. The effect of intraocular surgery on clear cornea graft. Amer. Jour. Ophth. 1970: 70:719-721. |
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]
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