title: Risk factors for failure of simultaneous penetrating keratoplasty and cataract extraction.
abstract: OBJECTIVE
  To evaluate the indications, complications, and outcomes of simultaneous cataract extraction and penetrating keratoplasty (PKP) and the risk factors for failure of the procedure.
  
  
  METHODS
  Tertiary referral medical center.
  
  
  METHODS
  In a retrospective noncomparative interventional case series, the charts of 66 consecutive patients (70 eyes) who had simultaneous PKP and cataract extraction using the same surgical technique were reviewed.
  
  
  RESULTS
  The mean follow-up was 32.4 months (range 6 to 125 months). The primary corneal graft remained clear in 48 eyes (69%) and failed in 22 eyes (31%). Sixteen eyes with a failed graft (73%) had 1 or 2 repeat keratoplasties; 8 (50%) were successful. At the end of follow-up, 56 eyes (80%) had a clear corneal graft. Nine eyes (41%) with a failed primary graft and 2 eyes (4%) with a clear primary graft had intracapsular cataract extraction (P<.001); 13 eyes (59%) and 46 eyes (96%), respectively, had extracapsular cataract extraction (P<.001). All eyes with a failed primary graft and 18 eyes (37%) with a clear primary graft had postoperative complications (P<.001). Eyes with a failed graft had more postoperative surgical interventions (P<.001). There were no statistical differences between eyes with clear grafts and eyes with failed grafts in sex, age, indications for surgery, corneal graft diameter, intraoperative vitreous loss, and intraocular lens placement.
  
  
  CONCLUSIONS
  Intracapsular cataract extraction, postoperative complications, and postoperative surgical interventions may increase the risk for graft failure in simultaneous cataract extraction and PKP. Intraocular lens implantation did not increase the risk for graft failure.
authors.affiliation: Department of Ophthalmology, Western Galilee-Nahariya Medical Center, Nahariya, Israel.
authors.forename: Valery
authors.initials: V
authors.lastname: Bersudsky
authors.forename: Uri
authors.initials: U
authors.lastname: Rehany
authors.forename: Shimon
authors.initials: S
authors.lastname: Rumelt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000009:adverse effects*; D002648:Child; D003316:Corneal Diseases / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D014792:Visual Acuity