Cataract formation after penetrating keratoplasty

To assess the incidence and risk factors for developing cataract after penetrating keratoplasty (PKP).

L.V. Prasad Eye Institute, Hyderabad, India.

This retrospective analysis of 251 phakic patients who had PKP between 1987 and 1994 assessed the incidence of and risk factors for cataract formation. Patients were assigned to one of two groups: Group 1 (n = 96), patients with keratoconus and corneal dystrophy; Group 2 (n = 88), patients with corneal scar and adherent leucoma. Preoperative, intraoperative, and postoperative lens details were noted. Data on intraoperative iris procedures (excess manipulation, pupilloplasty, synechiolysis, peripheral iridectomy) and postoperative topical steroid usage were assessed.

Sixty-seven patients were excluded because of incomplete lens status data. Of the remaining 184 patients, 45 (24.45%) developed cataract. Most cataracts (n = 31) developed within the first year of surgery. The incidence of cataract was significantly higher in Group 2 (n = 29) than in Group 1 (n = 16) (P = .0102). There was no significant between-group difference in mean steroid dose (P = .7064); however, the mean dose was significantly higher in eyes with cataracts (563 +/- 234 units) than in those without (479 +/- 127 units) (P = .0352). In Group 2, 9 of 20 patients who had synechiolysis, 1 of 3 who had pupilloplasty, and 2 of 5 who had peripheral iridectomy developed cataract. In Group 1, no patient had iris-related procedures.

Excessive steroid use and intraoperative iris manipulations are major risk factors for cataract formation after PKP.