The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion.
OBJECTIVE
The aim of this study was to investigate the visual and refractive outcome of combined penetrating keratoplasty, cataract extraction, and intraocular lens insertion (triple procedure) compared with cataract surgery following penetrating keratoplasty (sequential surgery).


METHODS
Retrospective cohort study of 1256 first penetrating keratoplasty for Fuchs' dystrophy performed between April 1999 and December 2005. In all, 1202 triple and 54 sequential procedures were reviewed. At 1 year, refractive outcomes were available for 499 triple procedure and 26 sequential surgery eyes. At 2 years, data were available for 264 triple procedure and 10 sequential surgery eyes. At 1 and 2 years postoperatively, graft survival, best-corrected visual acuity (BCVA), spherical equivalent, and cylindrical error were recorded. chi(2)-Tests were used to compare visual outcomes between the two groups.


RESULTS
At 1 year after triple procedure surgery, 61% of eyes attained BCVA of >or=6/12, with 47% of eyes within+/-2 D of emmetropia. After sequential surgery, 59% achieved BCVA of >or=6/12 with 67% of eyes within+/-2 D of emmetropia (=0.05). Mean spherical equivalent (MSE) at 1 and 2 years after triple procedure was +1.20 D (SD 5.45) and +0.15 D (SD 3.58), respectively. MSE following sequential surgery at 1 and 2 years was +0.08 D (SD 3.06) and -1.50 D (SD 3.14), respectively. Mean refractive cylinder after combined surgery was +4.16 D (SD 5.11) and +3.91 D (SD 2.79) at 1 and 2 years, respectively, compared with +3.65 D (SD 2.24) and +3.70 D (SD 2.06) after sequential surgery. In all, 29% of triple procedure and 27% sequential surgery eyes had an astigmatic error >or=5.0 D after 1 year (P=0.64), which increased to 34 and 30%, respectively, by the second year. The 5-year graft survival was 85% in both groups. There were no differences in graft survival, visual or refractive outcomes between triple procedure, and sequential surgery techniques.


CONCLUSIONS
This analysis provided no evidence of improved visual or refractive outcome after sequential surgery compared with triple procedure.
Nguyen
D Q
DQ
Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK. danqbnguyen@hotmail.com
Mumford
L L
LL
Jones
M N A
MN
Armitage
W J
WJ
Cook
S D
SD
Kaye
S B
SB
Tole
D M
DM
D000368:Aged; D002387:Cataract Extraction / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000379:methods*; D019654:Lens Implantation, Intraocular; D008297:Male; D012029:Refraction, Ocular; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity