Intraocular Lens Implantation After Penetrating Keratoplasty

Hsiao, Ching-Hsi; Chen, James J.Y.; Chen, Phil Y. F.; Chen, Henry S. L.

doi:10.1097/00003226-200108000-00005

Cited by 28 publications

(22 citation statements)

References 24 publications

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“…34,35,45,[48][49][50][51] However, improved surgical techniques and the use of intraocular viscoelastic agents may mean that secondary surgery can be performed with greater safety as suggested by a lower failure rate of 0-16% in more recent studies. 13,29,30,34,35,43,[49][50][51][52] Other authors have found no higher risk of graft failure from sequential surgery over triple procedure surgery, 13,28,35,46 with no significant difference in the percentage of endothelial cell loss 27,28 or increase in graft rejection episodes. 31 …”

Section: Graft Survivalmentioning

confidence: 97%

“…The visual outcomes we found after sequential surgery are comparable with previous studies of sequential surgery. 13,29,31,34,35 An advantage of sequential surgery is the ability to perform additional refractive surgery before and during the second operation. Hsiao et al 13 and Geggel 34 reported BCVA X6/12 in 81 and 86% from their 6 The use of K readings from the fellow eye does not provide reliable measurements.…”

Section: Bcvamentioning

confidence: 99%

“…13,29,31,34,35 An advantage of sequential surgery is the ability to perform additional refractive surgery before and during the second operation. Hsiao et al 13 and Geggel 34 reported BCVA X6/12 in 81 and 86% from their 6 The use of K readings from the fellow eye does not provide reliable measurements. 3 As post-PK corneal curvature cannot be accurately predicted in advance, 5 use of multiple regression analysis with surgeon-specific values, such as average postkeratoplasty K values, individualised A-constants, or fixed values for the anterior chamber depth has been advocated.…”

Section: Bcvamentioning

confidence: 99%

“…[27][28][29][30][31] The majority of studies evaluating triple surgery alone have shown approximately 50% of eyes achieve ±2 D of emmetropia, although the range of 26-95% within ± 2 D of emmetropia is rather wide. [3][4][5]9,10,13,[15][16][17][18][19][20][21][22]24,32,36 Supporters of sequential surgery highlight the potential for large ametropic errors with triple procedure surgery, arguing that IOL power can be calculated with greater accuracy when biometry is performed on a stable graft. 26,34 Sixty-seven percent of eyes that underwent sequential surgery in our study were within ±2 D of emmetropia at 1 year.…”

Section: Emmetropiamentioning

confidence: 99%

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The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion

Nguyen

Mumford

Jones

et al. 2008

Eye

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Purpose The aim of this study was to investigate the visual and refractive outcome of combined penetrating keratoplasty, cataract extraction, and intraocular lens insertion (triple procedure) compared with cataract surgery following penetrating keratoplasty (sequential surgery). Methods Retrospective cohort study of 1256 first penetrating keratoplasty for Fuchs' dystrophy performed between April 1999 and December 2005. In all, 1202 triple and 54 sequential procedures were reviewed. At 1 year, refractive outcomes were available for 499 triple procedure and 26 sequential surgery eyes. At 2 years, data were available for 264 triple procedure and 10 sequential surgery eyes. At 1 and 2 years postoperatively, graft survival, best-corrected visual acuity (BCVA), spherical equivalent, and cylindrical error were recorded. v 2 -Tests were used to compare visual outcomes between the two groups.Results At 1 year after triple procedure surgery, 61% of eyes attained BCVA of X6/12, with 47% of eyes within±2 D of emmetropia. After sequential surgery, 59% achieved BCVA of X6/12 with 67% of eyes within±2 D of emmetropia ( ¼ 0.05). Mean spherical equivalent (MSE) at 1 and 2 years after triple procedure was þ 1.20 D (SD 5.45) and þ 0.15 D (SD 3.58), respectively. MSE following sequential surgery at 1 and 2 years was þ 0.08 D (SD 3.06) and À1.50 D (SD 3.14), respectively. Mean refractive cylinder after combined surgery was þ 4.16 D (SD 5.11) and þ 3.91 D (SD 2.79) at 1 and 2 years, respectively, compared with þ 3.65 D (SD 2.24) and þ 3.70 D (SD 2.06) after sequential surgery. In all, 29% of triple procedure and 27% sequential surgery eyes had an astigmatic error X5.0 D after 1 year (P ¼ 0.64), which increased to 34 and 30%, respectively, by the second year. The 5-year graft survival was 85% in both groups. There were no differences in graft survival, visual or refractive outcomes between triple procedure, and sequential surgery techniques. Conclusions This analysis provided no evidence of improved visual or refractive outcome after sequential surgery compared with triple procedure.

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Section: Graft Survivalmentioning

confidence: 97%

Section: Bcvamentioning

confidence: 99%

Section: Bcvamentioning

confidence: 99%

Section: Emmetropiamentioning

confidence: 99%

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The visual and refractive outcomes of combined and sequential penetrating keratoplasty, cataract extraction, and intraocular lens insertion

Nguyen

Mumford

Jones

et al. 2008

Eye

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“…Nonsimultaneous procedures have been shown to carry no higher risk of transplant failure and no significant endothelial cell loss in comparison with triple procedures. However, the refractive error is significantly lower in the non-simultaneous group (Hsiao et al 2001;Shimmura et al 2003;Nagra et al 2004). Our study confirmed these results with significantly (p ¼ 0.0025) more patients achieving within ± 2 D of preoperative expected values.…”

Section: Applied Keratometry Values In Dioptresmentioning

confidence: 98%

Refractive error after triple and non‐simultaneous procedures: is the application of a standard constant keratometry value in IOL power calculation advisable?

Gruenauer-Kloevekorn

Kloevekorn-Norgall²,

Duncker

et al. 2006

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: The purpose of this investigation was to determine whether or not the use of a standard constant keratometry value in cases of preoperative abnormal keratometry values in biometry for triple procedures is advisable. Methods: Cataract surgery and penetrating keratoplasty were performed in 82 eyes; 53 eyes underwent triple procedures and 29 eyes underwent non-simultaneous procedures. A standard constant keratometry value of 42.50 D was applied in 18 triple-procedure eyes because the preoperative measured keratometry values were outwith the normal range (41)47 D). The spherical equivalent and expected values were compared after a mean follow-up of 20.5 months. Results: Cases in the triple-procedure group that achieved spherical equivalent within ± 2.0 D of expected values included nine of 18 eyes (50%) in which a standard constant keratometry value of 42.50 D was applied, three of 17 eyes (18%) in which keratometry values outwith the normal range were applied (p ¼ 0.044), and eight of 18 eyes (45%) in which keratometry values within the normal range were applied (p ¼ 0.862). Cases in the non-simultaneous procedure group that achieved spherical equivalent within ± 2.0 D of expected values included 22 of 24 eyes (92%) in which keratometry values within the normal range were applied (p ¼ 0.0025), and five of five eyes (100%) in which a standard constant keratometry value was applied. Conclusions: The application of a standard constant keratometry value of 42.50 D for intraocular lens power calculation in triple procedures can be recommended if abnormal keratometry values were measured previously. If possible, non-simultaneous procedures should take priority.

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