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[Cataract and keratoplasty--simultaneous or sequential surgery?].

Berthold Seitz1, Achim Langenbucher, Anja Viestenz

  • 1Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Erlangen. berthold.seitz@augen.imed.uni-erlangen.de

Klinische Monatsblatter Fur Augenheilkunde
|May 27, 2003
PubMed
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The triple procedure offers faster visual recovery for combined corneal and cataract issues. However, sequential approaches may lead to delayed rehabilitation, making the triple procedure the preferred method for simultaneous lens and corneal opacities.

Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Cataract Surgery

Background:

  • The triple procedure, combining penetrating keratoplasty (PK), extracapsular cataract extraction (CE), and intraocular lens (IOL) implantation, has been debated since the 1970s.
  • Surgeons continue to discuss the optimal surgical approach for patients with coexisting corneal disease and cataracts.

Purpose of the Study:

  • To compare the classical triple procedure with sequential approaches (CE before PK, and CE after PK) for combined corneal and cataract treatment.
  • To evaluate refractive outcomes and visual rehabilitation associated with different surgical strategies.

Main Methods:

  • Comparison of three surgical approaches: simultaneous triple procedure, CE + PCIOL before PK, and CE + PCIOL after PK.
  • Emphasis on intraoperative details for refractive success in the triple procedure, including precise trephination and graft/IOL centering.

Related Experiment Videos

  • Consideration of performing capsulorhexis under controlled intraocular pressure before trephination to minimize risks.

    • Main Results:

    • The triple procedure offers faster visual rehabilitation and less patient effort compared to sequential approaches.
    • Sequential approaches (CE before/after PK) carry increased risks of infection and suprachoroidal hemorrhage.
    • Approach (3) (CE after PK) allows for potential astigmatism correction but may increase risks of graft cell loss and allograft reactions; IOL calculation can be challenging due to corneal changes post-PK.

    Conclusions:

    • Despite potential refractive advantages of sequential approaches, the significantly delayed visual rehabilitation makes the triple procedure the method of choice for combined lens and corneal opacities.
    • The simultaneous triple procedure, especially with open-sky cataract extraction under general anesthesia, is recommended.
    • For elderly patients with Fuchs' dystrophy and developing cataracts, the simultaneous approach is advised due to the risk of rapidly progressing cataracts post-PK.