Management of coincidental corneal disease and cataract

The status of the cornea is crucial to a good outcome with cataract extraction. Preexisting corneal disease must be managed appropriately to get the high quality results that we have come to expect with modern day cataract surgery. It is now more common to perform cataract surgery on patients who have had previous corneal refractive surgery, and in these patients intraocular lens power calculation is more challenging. Complications following cataract surgery and lens implantation that involve the cornea are uncommon because of advances in surgical techniques. Corneal complications can include mechanical or toxic injury of the endothelium, stripped Descemet's membrane, epithelial toxicity and disruption, infectious keratitis, or epithelial ingrowth. Endothelial cell survival after cataract extraction and lens implantation is still the major concern. Healing of the cornea following clear corneal incisions has become more important, as this technique is used more frequently. There are several recent studies looking at the results of clear corneal incisions performed for cataract surgery. Patients with ocular surface disease still require extra lubrication and management of blepharitis to prevent epithelial toxicity at the time of surgery as well as postoperatively. Clear corneal cataract extraction and lens implantation cause minimal disruption of the conjunctiva, allowing cataract surgery to be performed in patients with severe ocular surface disease such as ocular cicatricial pemphigoid. Overall, modern day cataract extraction is very safe for the cornea.