Long-Term Outcomes Of Penetrating Keratoplasty With Versus Without Cataract Surgery

To compare long-term graft survival and postoperative glaucoma development in patients undergoing penetrating keratoplasty (PKP) with versus without combined cataract surgery

Patients who underwent PKP between 2010-2020 with a follow-up of 5-15 years were included in the study. Eyes that underwent penetrating keratoplasty (PKP) combined with cataract surgery and intraocular lens implantation (Group 1, n=103) were compared with eyes that underwent PKP alone (Group 2, n=344).PKP indications were similarly distributed between groups (keratoconus, corneal dystrophy, and corneal scars).

Patients’ age, indication for PKP, trephine size, donor punch size, graft survival, development of glaucoma, preoperative and postoperative best-corrected visual acuity (BCVA), and postoperative refractive error were evaluated. Patients with a history of preoperative glaucoma, anterior lamellar keratoplasty, graft rejection, active keratitis, corneal abscess, spontaneous corneal perforation, corneal neovascularization, bullous keratopathy, previous ocular surgery, or systemic diseases affecting the cornea were excluded.

Among combined procedures, extracapsular cataract extraction with intraocular lens implantation was the most commonly performed technique (58%). Graft rejection occurred in 17 eyes (16.5%) in Group 1 and 41 eyes (11.9%) in Group 2, with no statistically significant difference (p=0.433).Postoperative glaucoma developed in 25 eyes (24.3%) in Group 1 and 68 eyes (19.8%) in Group 2 (p=0.533). BCVA improved significantly postoperatively in both groups; however, postoperative BCVA was significantly better in Group 2 (1.06±1 vs 0.68±0.86; p=0.002).There were no significant differences between groups regarding glaucoma surgery (after PKP), trephine size, donor punch size, spherical and cylindrical refractive errors, or follow-up duration (p>0.05). 

In long-term follow-up, we did not observe a significant difference in graft rejection or postoperative glaucoma between patients who underwent PKP combined with cataract surgery and those who underwent PKP alone. We believe that combined surgery may be preferred in appropriately selected patients, and that close follow-up is essential for maintaining graft survival and for the early detection and management of glaucoma.