Concurrent Phacoemulsification with Foldable IOL implantation and Penetrating Keratoplasty pros and Cons : A case series

1. Jitendra Kumar Singh Parihar 1
2. jaya Kaushik 2
3. D P Vats 3
4. Hemant Singh Trehan4
5. Shantanu Mukherji 5
6. S K Mishra 6

Affiliation:
Authors no 1,2,4 ,5 and 6 : 1,2,3,5,and 6 Army Hospital (Research & Referral),New Delhi ,INDIA
Author no 3 :Affiliation: 6 Armed Forces Medical College Pune, INDIA

Purpose: To analyze the efficacy ,feasibility and functional outcome of concurrent Phacoemulsification and Penetrating Keratoplasty in selected cases of coexisting Cataract and Corneal Pathology.

Methods: This study is comprised of 31 eyes of 49 to 65 years of age group who had coexisting cataract and corneal pathology and underwent concurrent Phacoemulsification with IOL implantation and Penetrating Keratoplasty during 2005 to 2009 .The follow up was ranging between one to three years.IOL power calculation was done by using Keratometry of fellow eye if not possible in the same eye and axial length of the same eye. Presumed IOL power was estimated by reducing by 3.50 Dioptre to neutralize induced astigmatism. Partial thickness corneal button was excised in a fashion of LK prior to the commencement of Phacoemulsification so as to facilitates phacoemulsification .Capsulorhexis was done after Trypan blue staining . Nucleotomy was done by para central chop technique. Hydrophobic IOL implant was used in all cases. Full thickness corneal transplant was done subsequently by using combination of 8 interrupted and remaining continuous sutures .

Results :Mild to moderate uveitis was seen in 6 eyes, secondary glaucoma in 4 eyes ,however all managed medically. BCVA of 6/12 or better was attained in 27 eyes. Remaining eyes had compromised acuity due to graft or posterior segment changes . Induced astigmatism was within -/ + 2.75 Dioptre . Optically viable Graft was in 90% cases after three year.

Conclusion : Concurrent PK and Phacoemulsification is a definitive option in cases of coexisting Corneal opacities and Cataract .