Development and progression of cataract in patients required repeated corneal transplantation

To evaluate the incidence of cataract development in patients required repeated corneal transplantations, the types of cataract and the effect of cataract extraction on the corneal regrafts survival.

The charts of all the patients that underwent repeated corneal transplantation between 1985 and 1998 were reviewed for the development of cataract after the first or subsequent keratoplasties. In all, 80 patients underwent 122 repeated corneal transplantations, of which six underwent surgery in both eyes. The average follow-up period of all the patients with repeated keratoplasty was 89.5 months from the first keratoplasty.

Of 86 eyes 19 (22%) that underwent repeated keratoplasties developed cataract. The cataract developed between 1 month and 17 years (average 61.3 months) after the first transplantation. The incidence of cataract development was independent of the number of repeated keratoplasties. In certain patients, such as patients with acute and severe regraft immune rejection, the cataract progressed more rapidly. Despite different cataract extraction procedures, the grafts in 17 eyes of the 19 (89.5%) failed following cataract surgery and 16 of them underwent additional corneal regrafting. The regrafts in eight of the 16 regrafted eyes (50%) remained clear with improvement in visual acuity. At the end of the follow-up, 10 eyes of the 19 had clear regraft (53%) comparable with the rate of clear grafts in the entire regrafted group (51%, P=NS).

Corneal transplantation may be a trigger for slow development of cataract over years but repeated keratoplasties did not increase the risk for cataract development. Although failure of regrafts may occur after cataract extraction, subsequent corneal transplantation has a comparable survival and visual outcome with the entire regrafted group.