Visual And Refractive Outcomes Of Cataract Surgery Following Corneal Transplantation
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR146 | Type: Free paper | DOI: 10.82333/9s1j-6v63
Authors: Dr Seika Den* 1 , A/Prof. Yoichiro Masuda 2 , Dr Ryosuke Ito 2 , Dr Kyohei Sugawara 2 , Dr Kozue Kasai 2 , Ms Asuka Kobayashi 3 , Dr Ikuko Toda 3 , Prof. Dr Tadashi Nakano 2
1Ophthalmology,The Jikei University Katsushika Medical Center,Tokyo,Japan, 2Ophthalmology,The Jikei University School of Medicine,Tokyo,Japan, 3Minamiaoyama Eye Clinic Tokyo,Tokyo,Japan
Purpose
To evaluate the clinical outcomes of cataract surgery following keratoplasty, focusing on visual acuity (VA), corneal endothelial cell density (ECD), and refractive predictability, and to identify factors associated with postoperative outcomes.
Setting
Retrospective three-center study.
Methods
This study included 29 eyes who underwent cataract surgery after keratoplasty. The mean age was 63.2±10.8 years. Keratoplasty comprised penetrating keratoplasty (PK;16 eyes) and anterior lamellar keratoplasty (ALK;13). The most common indications for keratoplasty were keratoconus and regraft (8 each), following stromal keratitis (4). IOL power was calculated using the Barrett Universal (BU) formula group (15), Camellin-Calossi (CC;11), or SRK/T (3). K value was obtained using CASIA2® (15), IOL Master 7000® (13), and conventional keratometry (1). Mean axial length and K value were 25.2±2.7 mm and 44.6±5.3 D. The mean interval between keratoplasty and cataract surgery was 6.7±5.7 years. The mean follow-up period was 2.6±2.1 years.
Results
Pre-op logMAR VA improved significantly from 0.64±0.37 to 0.38±0.38 postoperatively (p=0.0007). Mean ECD was 1516±767 cells/mm2 and decreased to 1282±674 postoperatively (mean reduction rate 2.9±35.4%) without significance. The mean prediction error (PE) was -0.08±2.86 D, with a mean absolute error of 1.89±2.12 D; 37.9% and 75.9% of eyes were within ±1.00 D and ±2.00 D of target. Bland-Altman analysis revealed a near-zero bias of -0.08 D (95% CI: -1.13 to +0.96 D). ALK showed narrower LoA (8.70 D) than PK (13.23D). LoA widths were 8.31 D (BU), 14.02 D (CC), and 15.17 D (SRK/T), with no significant intergroup differences. Follow-up period correlated significantly with PE (ρ=−0.384, p=0.040). No variable was significantly associated with VA.
Conclusions
Cataract surgery following corneal transplantation resulted in significant visual improvement without clinically meaningful endothelial cell loss. Although the overall systematic bias was minimal, wide limits of agreement indicated substantial refractive variability. The BU formula group showed numerically narrower agreement limits; however, refractive predictability remained limited across graft types and IOL formulas. These findings suggest that, while cataract surgery in post-keratoplasty eyes is feasible and visually beneficial, refractive outcomes remain intrinsically variable. Prediction error correlated with follow-up period, suggesting that refractive stability in post-keratoplasty eyes may evolve over time.