Surgical management of coexisting corneal and lens opacities: one-stage vs two-stage approach

Purpose
The aim was to compare the refractive and visual outcome of the triple procedure
and the sequential surgery and to report any adverse effects or complications of
each approach.
Patients and methods
Forty eyes of 40 patients with corneal opacity and visually significant cataract were
divided into two equal groups: the triple group (group I) and the sequential group < br />(group II). In group I, patients underwent PKP with cataract extraction by either
open sky ECCE technique or phacoemulsification according to the degree of
corneal clarity. In group II, patients first underwent PKP then scheduled for
phacoemulsification and intraocular lens implantation. All patients were followed
up for 1 year, and data including the visual acuity, refractive outcome, ECC and
complications were recorded and analyzed.
Pkp penetrating keratoplasty ECCE extracapsular catarct extraction
Results
After 1 year of follow-up, the mean best corrected visual acuity (BSCVA) was 0.35
±0.13, with 45%of eyes with BSCVA greater than or equal to 0.5 in group I. In group < br />II, the mean BSCVA was 0.52±0.12 (P=0.021), with 60% of eyes with BSCVA
greater than or equal to 0.5(P=0.14). Mean spherical equivalent after triple
procedure was −1.6±0.2 D. Mean spherical equivalent following sequential
surgery was −0.29±0.24D (P=0.00). The mean cylinder after combined surgery
was −3.85±1.21, compared with −3.45±0.82D after sequential surgery (P=0.231).
Overall, 50%of group I and 70.0% of group II patients were within ±2D of the target
refraction (P=0.19). No significant difference in the mean ECC was found at the end
of follow-up period (P=0.524).
Conclusion
Planned phacoemulsification after PKP is a safe and effective approach for
management of coexisting lens and corneal opacity