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Cataract surgery after therapeutic keratoplasty: what to anticipate

Poster Details

First Author: A.Raghavan INDIA

Co Author(s):    S. Somapalan                    

Abstract Details


To analyze the outcomes of cataract surgery in eyes with prior therapeutic keratoplasty. To evaluate potential risk factors, and highlight management strategies to maintain graft clarity post-operatively.


In-Patient and Out-Patient Departments of Aravind Eye Hospital, Coimbatore, India.


A retrospective analysis of 13 patients with clear grafts and cataracts after therapeutic keratoplasty were included in the study. The following were analyzed for their impact on post-cataract surgery outcomes: episodes of rejection prior to cataract surgery, time to cataract surgery, the type of cataract surgery, and pre-operative specular counts. Efficacy of intraocular lens power (IOL) calculation, and best corrected visual acuity (BCVA), were also noted. The incidence of graft rejection post-cataract surgery, prevention and management, and its impact on graft survival were also noted.


Post -keratoplasty follow –up ranged from 17 to 89 months. Pre-operative rejection occurred in 46%. The time frame before cataract surgery was 7-80 months. The specular count ranged from 478-1300, with 8 patients having counts less than 1000. The Orbscan method and the IOL master were used for calculations. Except for one, all patients underwent small incision cataract surgery. 69% had graft rejection after surgery - mostly occurring in the first 4 months after surgery. Only one graft failed. BCVA ranged from 6/6 to 6/36. Except for 3 patients with low degrees of spherical correction, others had astigmatism only.


Good outcomes are possible after cataract surgery in eyes with prior therapeutic keratoplasty, in spite of complicated surgical procedures and borderline specular counts. The incidence of graft rejection increases in the peri-operative period and necessitates very close follow-up and very slow steroid taper.

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