Corneal Pathology and Cataract: Combined Surgery or Sequential Surgery?

To compare our combined surgery (CS) and sequential surgery (SS) results.

The files of 44 patients who underwent CS (penetrating keratoplasty [PK], cataract extraction, and intraocular lens [IOL] implantation) and 126 patients who underwent SS (cataract extraction and IOL implantation in a second session after PK) between January 2009 and December 2018 were evaluated retrospectively. One eye of the patients who were followed up for at least 1 year was included in the study. The two groups were compared in terms of indications, corrected distance visual acuity (CDVA), refractive results, complications, and graft survival.

In the CS and SS groups, the median age was 63 (30-79) and 43 (18-73) years (p<0.001) and the median follow-up time was 51 (13-152) and 64.5 (13-154) months (p=0.011), respectively. The most common PK indications were traumatic corneal scar (20.5%) and endothelial dystrophy (15.9%) in the CS group versus keratoconus (24.6%) and stroma dystrophy (17.5%) in the SS group. In the CS and SS groups, 50% vs 69% of patients had CDVA ≥0.4 (p=0.04); 45.5% vs 25.4% had CDVA (0.1-0.3) (p=0.04); and 54.5% vs 73% had spherical equivalent ≤±2.0 D (p=0.02). The most common postoperative complications were glaucoma (20.5% vs 15.9%, p=0.48) and allograft reaction (9.1% vs 23%, p=0.04). Graft survival rates were 95.2% vs 86.5% (p=0.10) at 1 year and 75.9% vs 68.9% (p=0.47) at 5 years, respectively.

Over long-term follow-up, the groups were similar in terms of graft survival. For this reason, each patient must be evaluated separately whether to perform a combined or sequential surgery. Given the lower refractive error and higher expectation of final visual acuity, SS can be more advantageous especially in young patients.