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Cataract after penetrating keratoplasty: a real complication or not?

Poster Details

First Author: I. Dekaris CROATIA

Co Author(s):    A. Dukic   M. Koncarevic   A. Pasalic   M. Pauk-Gulic     

Abstract Details


Cataract after corneal transplantation (CT) is for long time considered as a complication which may jeopardize the corneal graft due to endothelial cell density (ECD) loss during phaco. However, phaco has become a very safe procedure, which is used even in patients with a clear lens to correct their refractive error. In patients with full-thickness corneal graft refractive error is the main obstacle limiting full visual recovery. The aim of this study was to evaluate refractive outcome and possible complications of cataract surgery in patients with corneal graft.


University Eye Hospital, Svjetlost, Zagreb, Croatia


Design: Prospective case series. Methods: In 32 post-CT eyes with mainly soft posterior subcapsular cataract, phaco with implantation of hydrophobic acrylic IOL was performed. All surgeries were done after the suture removal, in patients aged 20 to 75 years. Preoperative measurements included: best corrected visual acuity (BCVA), corneal topography, corneal aberrometry, endothelial cell density (ECD) count and IOL power calculation. 50 post-CT eyes which were not submitted to phaco served as control. Postoperatively patients were followed for at least two years. The outcome measures were: BCVA, change in refractive error, ECD loss, graft survival and complication rate. Results: The mean preoperative spherical equivalent (SE) was 2.84±3.6 D, and mean refractive astigmatism was 4.56±6.4 D. Preoperative BCVA was ≤ 0.5 in all cases. Mean phaco time was 2.34 ± 1.7 sec. The mean SE decreased to of 1.12±1.4 D and refractive astigmatism to 3.2±3 D. BCVA improved to an average of 0.8. ECD loss caused by phaco: preop ECD was 1910±282 cells/mm2 and post-phaco 1781±270 (at 1 month) and 1586±174 cells/mm2 (at 12 months); which was not significantly different compared to post-CT eyes without Phaco surgery (1897.86±250 at 1 month and 1693±25 at 12 months). No complications occurred during Phaco and all grafts remained clear.


Phaco after CT corrected most of the pre-existing refractive error, bringing patients to better BCVA compared to pre-cataract phase. No significant ECD loss or serious complications were recorded. Thus, post-CT cataract formation may be nowadays considered as a “relative” CT complication.



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