Intraocular lens implantation after penetrating keratoplasty

Purpose. We evaluated the clinical results of nonsimultaneous penetrating k eratoplasty, cataract extraction, and intraocular lens (IOL) implantation ( two-stage surgery) for combined corneal disease and cataract. Methods. Twen ty-six eyes of 24 patients with an average age of 46 years who underwent tw o-sta,ge surgery were studied retrospectively. Variables included visual ac uity, refractive status, specular microscopy before and after IOL implantat ion (6 months), and the occurrence of graft failure. Astigmatism was correc ted by suture removal and relaxing incision. The mean follow-up after IOL p lacement was 16 months. Results. Unaided visual acuity was 20/100 or better in 22 (83%) eyes after the second procedure. Twenty-one (81%) eyes had an aided visual acuity of at least 20/40. The mean refractive and absolute err ors were -1.49 +/- 1.39 diopters (D) and 1.55 +/- 1.30 D, respectively. The mean keratometric and refractive cylinders were 3.50 D and 2.26 D, respect ively. Nineteen (73%) eyes had a spherical equivalent refraction within 2 D of emmetropia. Anisometropia (greater than or equal to 3 D) occurred in fo ur (15%) eyes. The endothelial cell density, the coefficient of variation, and the percentage of hexagonal cells documented by specular microscopy wer e not significantly different before and after IOL implantation. Complicati ons included three rejections, two cases of herpetic recurrence, and one la te decompensation. Two graft failures (8%) occurred after secondary surgery . Conclusion. The two-stage surgery is a safe and effective modality.