Corneal Pathology and Cataract: Combined Surgery or Sequential Surgery?

Area of Science:

• Ophthalmology
• Corneal Surgery
• Cataract Surgery

Background:

• Penetrating keratoplasty (PK) is often combined with cataract surgery for patients with corneal opacity and lens-seated pathology.
• The choice between combined surgery (CS) and sequential surgery (SS) for PK and cataract extraction involves evaluating visual outcomes, refractive results, and complications.

Purpose of the Study:

• To compare the outcomes of combined surgery (CS) versus sequential surgery (SS) in patients undergoing penetrating keratoplasty (PK) and cataract extraction with intraocular lens (IOL) implantation.

Main Methods:

• Retrospective evaluation of 44 patients undergoing CS and 126 patients undergoing SS between 2009 and 2018.
• Comparison included indications for PK, corrected distance visual acuity (CDVA), refractive outcomes, complications, and graft survival over at least one year of follow-up.

Main Results:

• The SS group was younger (median age 43 vs 63 years) and had a longer follow-up (64.5 vs 51 months).
• While graft survival was similar long-term (75.9% vs 68.9% at 5 years), the SS group showed better CDVA (≥0.4: 69% vs 50%) and lower refractive error (spherical equivalent ≤±2.0 D: 73% vs 54.5%).
• Allograft reaction was more common in the SS group (23% vs 9.1%).

Conclusions:

• Long-term graft survival is comparable between CS and SS.
• Sequential surgery may be advantageous for younger patients due to potentially better refractive outcomes and higher final visual acuity expectations.
• Individual patient evaluation is crucial for deciding between combined and sequential surgical approaches.