Simultaneous and non-simultaneous penetrating keratoplasty and cataract surgery for Fuchs' corneal endothelial dystrophy and cataract

ABSTRACT

To determine outcome of simultaneous and non-simultaneous penetrating keratoplasty and cataract surgery in eyes with Fuchs' dystrophy and cataract. The medical records of all patients with a histopathologically confirmed diagnosis of Fuchs' dystrophy who underwent penetrating keratoplasty at the University of Iowa Hospitals and Clinics between January 1, 1990 and December 31, 1999 and who had also undergone cataract extraction and intraocular lens implantation prior to December 31, 2001 were retrospectively reviewed. Patients were assigned to group 1 [cataract surgery followed by penetrating keratoplasty], group 2 [simultaneous penetrating keratoplasty and cataract surgery], and group 3 [penetrating keratoplasty followed by cataract surgery]. Two hundred and twelve eyes met the inclusion criteria. Among these, there were 48 cases in which cataract extraction and IOL implantation was performed prior to penetrating keratoplasty [group 1], 154 in which all three procedures were performed simultaneously [group 2], and 10 in which cataract surgery was performed after penetrating keratoplasty [group 3]. There were no statistically significant differences between the 3 groups with respect to the percentage of eyes that obtained a final visual acuity of 20/40 or better or 20/200 or worse. There were also no statistically significant differences between the 3 groups with respect to graft survival. Patients in group 3 were more likely to have refractive IOL predictability to within 2D of emmetropia than those in group 1 [80.0% vs. 56.1%] and those in group 2 [80.0% vs. 48.0%], but these differences were not statistically significant [P = 0.08, 0.09, respectively]. The performance of either simultaneous or non-simultaneous cataract surgery with penetrating keratoplasty in eyes with Fuchs' dystrophy has no significant effect on visual outcome or graft survival. Cataract surgery performed subsequent to penetrating keratoplasty is associated with a better refractive outcome: