Correction of postkeratoplastic ametropia in patients with cataract

Abstract

BACKGROUND: Penetrating keratoplasty leads, on the one hand, in 100% of cases, to the formation of induced astigmatism of variable degree, on the other hand, to a decrease in the density of endothelial cells of the corneal graft, which can reach from 19.1 to 38.3%. Thus, today the task of safe cataract extraction with minimal loss of density of endothelial cells and maximal correction of corneal astigmatism by the aid of an implantation of a toric intraocular lens is paramount. AIM: The aim of the study is to conduct a clinical and functional analysis of cataract phacoemulsification with a toric intraocular lens implantation in patients after previously performed penetrating keratoplasty. MATERIALS AND METHODS: We performed phacoemulsification with implantation of a toric intraocular lens in 25 eyes (25 patients) having a history of penetrating keratoplasty. The 1st degree of the lens nucleus density (according to Buratto classification) was noted in 4 eyes, the 2nd degree in 17 eyes, the 3rd degree in 4 eyes. According to keratotopography, all patients had a symmetrical type of postkeratoplastic astigmatism. The average follow-up period was 1 year. RESULTS: Intra- and postoperative complications were noted. One month after surgery, uncorrected visual acuity increased from an average of 1.3 1.6 to 0.3 0.9 LogMAR, best corrected visual acuity increased from 1.0 1.18 to 0.1 0.9 LogMAR, refractive astigmatism decreased from 7.5 2.43 to 1.43 0.38 D, and did not change during 1 year of follow-up. The density of endothelial cells decreased by 9% 1 year after surgery. CONCLUSIONS: Cataract phacoemulsification with a toric intraocular lens implantation in patients after previously performed penetrating keratoplasty allows achieving high refractive results. Preoperative analysis of endothelial cell density, careful approach to the intraocular lens calculation, and standard protocol of phacoemulsification make this operation predictable and safe.