Intraocular lens implantation after penetrating keratoplasty

Thirty-three postkeratoplasty eyes underwent extracapsular cataract extraction with posterior chamber lens implantation or secondary anterior chamber lens implantation 3 to 128 months following corneal transplantation. The mean follow-up after the secondary lens implantation was 24 months (range 2 to 70 months). Seven of the 33 corneas became cloudy 1 to 8 months after lens implantation. Prior to graft failure, 71% of the eyes achieved refractive errors within 2 diopters of emmetropia and 19 of 33 eyes (57%) achieved uncorrected visual acuities of 20/100 or better. In spite of surgical attempts to reduce preexisting astigmatism, the mean post-implant keratometry astigmatism was unchanged after secondary surgery. Compared with a concurrent series of triple procedures, the advantage of providing patients with refractive errors closer to emmetropia by performing surgery after a corneal transplant is outweighed by the increased risks to the graft, the increased costs and medical risks of two operations, the risk of increased astigmatism, and the delay in visual acuity recovery from the time of keratoplasty until obtaining a final refraction after secondary surgery.