Intraocular lens implantation after penetrating keratoplasty. Improved unaided visual acuity, astigmatism, and safety in patients with combined corneal disease and cataract.

Twenty-two eyes with combined corneal disease and cataract were followed prospectively after nonsimultaneous intraocular lens (IOL) placement after penetrating keratoplasty; the majority had a penetrating keratoplasty and planned extracapsular cataract extraction (ECCE) followed later by the placement of an IOL. The mean follow-up after IOL placement was 25 months (range, 3-55 months). No graft failures occurred after secondary surgery. All graft sutures were removed in 86% (19/22) of eyes before IOL surgery. Ninety-five percent (21/22) of the eyes achieved refractive errors within 2 diopters (D) of the desired result. Corneal astigmatism decreased from 4.88 to 2.92 D after secondary surgery and wound revision. Unaided visual acuity was 20/40 or better in 68% (15/22) and 20/100 or better in 91% (20/22) of the eyes. The advantages of excellent unaided visual acuity, reduced astigmatism, and lack of anisometropia and graft failure outweigh the disadvantage of some delay in final visual rehabilitation (11 months) and increased secondary capsulotomy rate (85%) in this series with two separate surgeries compared with previously reported triple procedure results.