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. 2023 Jul 21:10:1190485.
doi: 10.3389/fmed.2023.1190485. eCollection 2023.

Combined versus sequential penetrating keratoplasty and cataract surgery for herpes simplex keratitis: a retrospective study

Yani Wang  1   2 , Jun Cheng  2   3 , Nannan Yang  2   3 , Ting Li  2   3 , Yanling Dong  2   3 , Lixin Xie  2   3
Affiliations

Combined versus sequential penetrating keratoplasty and cataract surgery for herpes simplex keratitis: a retrospective study

Yani Wang et al. Front Med (Lausanne). .

Abstract

Purpose: To compare the surgical outcomes of combined penetrating keratoplasty (PK) and cataract surgery with those of sequential surgery (cataract surgery after PK) for herpes simplex keratitis (HSK).

Methods: The medical records of consecutive patients diagnosed with HSK who underwent combined or sequential PK and cataract surgery in active and stable stages between June 2015 and June 2022 were reviewed retrospectively. Complications, graft survival, endothelial cell density (ECD), and final BCVA were compared and analyzed between both surgical methods in each stage.

Results: A total of 171 eyes of 171 patients were enrolled, including active stage (69 combined, 46 sequential) and stable stage (34 combined, 22 sequential). The average follow up was 24.2 ± 15.8 months (range, 3 months - 48 months). The final BCVA had obvious improvement and the postoperative ECD was not different in combined and sequential groups of each stage. In sequential group of active stage, 66.7% of persistent epithelial defects and 50% of HSK recurrence occurred within 3 months after cataract surgery; nevertheless, compared to that in sequential group, capsular rupture (p = 0.021), persistent epithelial defects (p = 0.027), and HSK recurrence (p = 0.035) occurred more frequently in combined group, leading to a lower graft survival rate (p = 0.045); at the last visit, 46.4 and 67.4% of grafts remained clear in combined and sequential groups, respectively. By contrary, 82.4 and 50.0% of grafts remained clear in stable stages of combined and sequential groups at the last visit, respectively, and a higher graft survival rate was observed in combined group (p = 0.030).

Conclusion: Although the postoperative ECD is not different between two surgical groups in each stage, sequential surgery in active stage of HSK seems to have advantages in less complications and higher graft survival rate, whereas combined surgery in stable stage has a better outcome than that in sequential surgery.

Keywords: cataract surgery; endothelial cell density; graft survival; herpes simplex keratitis; penetrating keratoplasty.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Graph showing the distribution of BCVA(log Mar) at final follow-up in two stages of HSK.
Figure 2
Figure 2
Graph showing the change of ECD after two surgical groups in active stage (A) and stable stage (B) of HSK.
Figure 3
Figure 3
Graph showing graft survival rate after combined and sequential surgeries in active stage (A) and stable stage (B) of HSK.
See this image and copyright information in PMC

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References

    1. Wan X, Yao W, Zhao S, Xu J, Le Q. Indications and surgical techniques for repeat corneal transplantation in eastern China: a twelve-year study. J Ophthalmol. (2021) 2021:5514004. doi: 10.1155/2021/5514004.eCollection 2021 - PMC - PubMed
    1. Greene JB, Mian SI. Cataract surgery in patients with corneal disease. Curr Opin Ophthalmol. (2013) 24:9–14. doi: 10.1097/ICU.0b013e32835aeec4 - DOI - PubMed
    1. Sridhar MS, Murthy S, Bansal AK, Rao GN. Corneal triple procedure: indications, complications, and outcomes: a developing country scenario. Cornea. (2000) 19:333–5. doi: 10.1097/00003226-200005000-00015 - DOI - PubMed
    1. Shimmura S, Ohashi Y, Shiroma H, Shimazaki J, Tsubota K. Corneal opacity and cataract: triple procedure versus secondary approach. Cornea. (2003) 22:234–8. doi: 10.1097/00003226-200304000-00010 - DOI - PubMed
    1. Acar BT, Buttanri IB, Sevim MS, Acar S. Corneal endothelial cell loss in post-penetrating keratoplasty patients after cataract surgery: phacoemulsification versus planned extracapsular cataract extraction. J Cataract Refract Surg. (2011) 37:1512–6. doi: 10.1016/j.jcrs.2011.03.039 - DOI - PubMed

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