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. 2021 Feb 25;51(1):1-6.
doi: 10.4274/tjo.galenos.2020.04382.

Corneal Pathology and Cataract: Combined Surgery or Sequential Surgery?

Selma Özbek Uzman  1 , Züleyha Yalnız Akkaya  1 , Emrah Düzova  1 , Evin Şingar  1 , Ayşe Burcu  1
Affiliations

Corneal Pathology and Cataract: Combined Surgery or Sequential Surgery?

Selma Özbek Uzman et al. Turk J Ophthalmol. .

Abstract

Objectives: To compare our combined surgery (CS) and sequential surgery (SS) results.

Materials and methods: The files of 44 patients who underwent CS (penetrating keratoplasty [PK], cataract extraction, and intraocular lens [IOL] implantation) and 126 patients who underwent SS (cataract extraction and IOL implantation in a second session after PK) between January 2009 and December 2018 were evaluated retrospectively. One eye of the patients who were followed up for at least 1 year was included in the study. The two groups were compared in terms of indications, corrected distance visual acuity (CDVA), refractive results, complications, and graft survival.

Results: In the CS and SS groups, the median age was 63 (30-79) and 43 (18-73) years (p<0.001) and the median follow-up time was 51 (13-152) and 64.5 (13-154) months (p=0.011), respectively. The most common PK indications were traumatic corneal scar (20.5%) and endothelial dystrophy (15.9%) in the CS group versus keratoconus (24.6%) and stroma dystrophy (17.5%) in the SS group. In the CS and SS groups, 50% vs 69% of patients had CDVA ≥0.4 (p=0.04); 45.5% vs 25.4% had CDVA (0.1-0.3) (p=0.04); and 54.5% vs 73% had spherical equivalent ≤±2.0 D (p=0.02). The most common postoperative complications were glaucoma (20.5% vs 15.9%, p=0.48) and allograft reaction (9.1% vs 23%, p=0.04). Graft survival rates were 95.2% vs 86.5% (p=0.10) at 1 year and 75.9% vs 68.9% (p=0.47) at 5 years, respectively.

Conclusion: Over long-term follow-up, the groups were similar in terms of graft survival. For this reason, each patient must be evaluated separately whether to perform a combined or sequential surgery. Given the lower refractive error and higher expectation of final visual acuity, SS can be more advantageous especially in young patients.

Keywords: Combined surgery; open-sky cataract extraction; penetrating keratoplasty; phacoemulsification and intraocular lens implantation; sequential surgery.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

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