Comprehensive Approach To Cataract Surgery At Different Stages Of Keratoprosthesis Implantation

To evaluate the comprehensive approach to cataract extraction at various stages of keratoprosthesis implantation in patients with vascular leucoma and lens opacification.

The study enrolled 30 patients (30 eyes) aged from 16 to 74 with vascular leucoma of various etiologies and lens opacification. All patients underwent multi-stage surgical treatment, including keratoprosthesis implantation and cataract extraction. The stage and extent of surgical intervention were determined individually, according to the patient’s clinical and functional data, lens density and previously performed optical reconstructive surgery.

Patients were divided into three study groups based on the timing and extent of the surgical procedure performed. Group I included 10 patients (10 eyes) that underwent cataract extraction simultaneously with corneal-prosthetic complex transplantation and anterior chamber reconstruction. Group II included 15 patients (15 eyes) that underwent cataract extraction either during the second stage of keratoprosthesis implantation (through the optical cylinder aperture) or during the optical cylinder replacement. Group III included 5 patients (5 eyes) that underwent cataract extraction in the late postoperative period after keratoprosthesis implantation, performed by phacoemulsification or intracapsular cataract extraction.

All patients presented good clinical and functional results. Best corrected visual acuity in the first group was 0,43 ± 0,27, in the second group 0,42 ± 0,28, in the third group 0,41± 0,32.  The keratoprosthesis position was stable during the entire follow-up period.

Cataract extraction in patients with keratoprosthesis is a challenging procedure with high risk of intra- and postoperative complications at all stages of treatment. During corneal-prosthetic complex transplantation, lens removal should be done in all cases, regardless of the lens opacification degree. In patients with keratoprosthesis cataract extraction through the optical cylinder aperture should be performed as early as possible. Moreover, the possibility of unplanned vitreoretinal intervention should be considered. The operation technique is more difficult compared to the conventional technology and requires more experience of the surgeon.