title: Sequential versus combined penetrating keratoplasty and cataract surgery.
abstract: OBJECTIVE
  To compare the refractive and visual outcomes of combined penetrating keratoplasty and cataract surgery (triple procedure) with those of sequential surgery (penetrating keratoplasty followed by secondary cataract extraction and posterior chamber intraocular lens implantation).
  
  
  METHODS
  Forty-six consecutive patients undergoing triple procedure or sequential surgery performed by two surgeons were reviewed retrospectively. The triple procedure group consisted of 23 patients and the sequential surgery group also consisted of 23 patients. Refractive and visual outcomes were collected and analyzed with at least 1 year of follow-up for both groups. Both the difference from target and the variability of the refractive outcome were analyzed.
  
  
  RESULTS
  Best spectacle corrected visual acuity of 6/12 or better was achieved in 16 eyes (69.8%) in the triple procedure group and in 19 eyes (82.6%) in the sequential surgery group. For both the triple and sequential groups, there was no difference between the mean postoperative refractive outcome (-2.73/+1.05 x 109 SD = 4.30/1.42/4.43) and (-1.33/+0.79 x 175 SD = 2.39/1.16/2.33) compared with the mean target refraction (-0.77, SD = 1.16 and -0.43, SD = 0.99), (p = 0.39 and 0.48), respectively. In addition, there was no significant difference in the variability of the refractive outcome between the two groups (p > 0.99).
  
  
  CONCLUSIONS
  Sequential surgery appears to offer no significant advantages over the triple procedure in terms of refractive predictability or variability. There was a slight trend toward more patients achieving 6/12 or better vision in the sequential group.
authors.affiliation: Ophthalmology Department, St Paul's Eye Unit, Royal Liverpool University Hospital, Prescott Street, Liverpool L7 8xP, United Kingdom. jcazabon@hotmail.com
authors.forename: Sunildath
authors.initials: S
authors.lastname: Cazabon
authors.forename: Say Aun
authors.initials: SA
authors.lastname: Quah
authors.forename: Mark N A
authors.initials: MN
authors.lastname: Jones
authors.forename: Mark
authors.initials: M
authors.lastname: Batterbury
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D005139:Eyeglasses; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating / Q000009:adverse effects; D019654:Lens Implantation, Intraocular; D008875:Middle Aged; D011184:Postoperative Period; D012029:Refraction, Ocular; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult