Visual Rehabilitation in Combined Cataract Extraction, IOL Placement, and Corneal Transplant, Phaco vs. ECCE

Abstract

Purpose: : To investigate the rapidity of visual rehabilitation in patients who had a combined cataract extraction with implantation of an intraocular lens (IOL) and corneal transplant using either the phacoemulsification (PHACOPKP) or extracapsular (ECCEPKP) method.

Methods: : A retrospective chart review of cases from one surgeon performed from 2000–2005 identified 62 eyes; 29 with PHACOPKP and 33 with ECCEPKP. Traditional ECCEPKP was done from 2000–2003 and the PHACOPKP method was used since then. Eyes with severe retinal or optic nerve disease were excluded. In the ECCEPKP method the host cornea was removed followed by an open–sky cataract extraction and non–foldable IOL insertion. After this, implantation of the donor cornea was performed. In the PHACOPKP method, the cataract extraction and foldable IOL insertion was performed under a closed system followed by corneal transplantation. We measured the best corrected visual acuity (BCVA) using either pinhole or refraction at 1, 2, 4, and 6 months.

Results: : In the PHACOPKP group, we found 21 patients to have Fuchs dystrophy or corneal edema, 4 with corneal scars, and 4 with other diagnoses. In the ECCEPKP group, 20 patients had Fuchs or edema, 7 had scars, and 6 had other diagnoses. In the PHACOPKP group, 1 month postoperative, 40% of eyes had BCVA <20/200, 28% were 20/60–20/100, and 31% were >20/50. Median vision was 20/100. At 2 months, 14% had BCVA <20/200, 46% were 20/60–20/100, and 39% were >20/50. Median vision was 20/70. At 4 months, 7% had BCVA <20/200, 32% were 20/60–20/100, and 61% were >20/50. Median vision was 20/50. 6 month results were similar with a median vision of 20/40. In the ECCEPKP group, 1 month postoperative, 82% of eyes had BCVA <20/200, 15% were 20/60–20/100, and 3% were >20/50. Median vision was 20/300. At 2 months, 43% had BCVA <20/200, 40% were 20/60–20/100, and 16% were >20/50. Median vision was 20/100. At 4 months, 23% had BCVA <20/200, 42% were 20/60–20/100, and 35% were >20/50. Median vision was 20/60. At 6 months, 6% had BCVA <20/200, 29% were 20/60–20/100, and 65% were >20/50. Median vision was 20/50.

Conclusions: : Patients undergoing combined cataract extraction with IOL and corneal transplant had a faster visual recovery with the PHACOPKP method vs. the ECCEPKP method. Therefore we suggest PHACOPKP should be the preferred method in those patients where the cornea is clear enough to perform the procedure.

Keywords: cornea: clinical science • cataract • intraocular lens