title: Intraocular lens implantation after penetrating keratoplasty.
abstract: OBJECTIVE
  We evaluated the clinical results of nonsimultaneous penetrating keratoplasty, cataract extraction, and intraocular lens (IOL) implantation (two-stage surgery) for combined corneal disease and cataract.
  
  
  METHODS
  Twenty-six eyes of 24 patients with an average age of 46 years who underwent two-stage surgery were studied retrospectively. Variables included visual acuity, refractive status, specular microscopy before and after IOL implantation (6 months), and the occurrence of graft failure. Astigmatism was corrected by suture removal and relaxing incision. The mean follow-up after IOL placement was 16 months.
  
  
  RESULTS
  Unaided visual acuity was 20/100 or better in 22 (83%) eyes after the second procedure. Twenty-one (81%) eyes had an aided visual acuity of at least 20/40. The mean refractive and absolute errors were -1.49 +/- 1.39 diopters (D) and 1.55 +/- 1.30 D, respectively. The mean keratometric and refractive cylinders were 3.50 D and 2.26 D, respectively. Nineteen (73%) eyes had a spherical equivalent refraction within 2 D of emmetropia. Anisometropia (> or =3 D) occurred in four (15%) eyes. The endothelial cell density, the coefficient of variation, and the percentage of hexagonal cells documented by specular microscopy were not significantly different before and after IOL implantation. Complications included three rejections, two cases of herpetic recurrence, and one late decompensation. Two graft failures (8%) occurred after secondary surgery.
  
  
  CONCLUSIONS
  The two-stage surgery is a safe and effective modality.
authors.affiliation: Department of Ophthalmology, Chang-Gung Memorial Hospital, Taipei, Taiwan. qq_hsiao@yahoo.com
authors.forename: C H
authors.initials: CH
authors.lastname: Hsiao
authors.forename: J J
authors.initials: JJ
authors.lastname: Chen
authors.forename: P Y
authors.initials: PY
authors.lastname: Chen
authors.forename: H S
authors.initials: HS
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000209:etiology / Q000601:surgery; D002387:Cataract Extraction; D002452:Cell Count; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015948:Keratoplasty, Penetrating; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012029:Refraction, Ocular; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity