Femtosecond laser-assisted cataract surgery after penetrating keratoplasty: a case report

Correction of postkeratoplastic ametropia in patients with cataract

BACKGROUND: Penetrating keratoplasty leads, on the one hand, in 100% of cases, to the formation of induced astigmatism of variable degree, on the other hand, to a decrease in the density of endothelial cells of the corneal graft, which can reach from 19.1 to 38.3%. Thus, today the task of safe cataract extraction with minimal loss of density of endothelial cells and maximal correction of corneal astigmatism by the aid of an implantation of a toric intraocular lens is paramount. AIM: The aim of the study is to conduct a clinical and functional analysis of cataract phacoemulsification with a toric intraocular lens implantation in patients after previously performed penetrating keratoplasty. MATERIALS AND METHODS: We performed phacoemulsification with implantation of a toric intraocular lens in 25 eyes (25 patients) having a history of penetrating keratoplasty. The 1st degree of the lens nucleus density (according to Buratto classification) was noted in 4 eyes, the 2nd degree in 17 eyes, the 3rd degree in 4 eyes. According to keratotopography, all patients had a symmetrical type of postkeratoplastic astigmatism. The average follow-up period was 1 year. RESULTS: Intra- and postoperative complications were noted. One month after surgery, uncorrected visual acuity increased from an average of 1.3 1.6 to 0.3 0.9 LogMAR, best corrected visual acuity increased from 1.0 1.18 to 0.1 0.9 LogMAR, refractive astigmatism decreased from 7.5 2.43 to 1.43 0.38 D, and did not change during 1 year of follow-up. The density of endothelial cells decreased by 9% 1 year after surgery. CONCLUSIONS: Cataract phacoemulsification with a toric intraocular lens implantation in patients after previously performed penetrating keratoplasty allows achieving high refractive results. Preoperative analysis of endothelial cell density, careful approach to the intraocular lens calculation, and standard protocol of phacoemulsification make this operation predictable and safe.

Survival of the fittest: phacoemulsification outcomes in four corneal transplants by Dr Ramon Castroviejo

AIM

To evaluate and report the outcomes following phacoemulsification on four eyes, 45 years or more after corneal transplantation.

METHODS

A retrospective case series of four eyes in three patients (P1, P2, P3), undergoing phacoemulsification at least 45 years after corneal transplantation by Dr Ramon Castroviejo. Corneal graft survival outcome measures included central corneal thickness (CCT), best-corrected visual acuity (BCVA), corneal clarity and endothelial cell count (ECC).

RESULTS

Phacoemulsification was successfully completed in all four cases with no instances of graft failure during the postoperative follow-up period, which ranged from 17 months to 76 months. At the conclusion of the follow-up period, all four grafts remained clear, and BCVA remained better than or similar to preoperative values. Long-term follow-up revealed no meaningful changes in CCT after phacoemulsification. All but one case experienced a decrease in ECC, with ECC values in the four cases ranging from 538 cells/mm² to 1436 cells/mm² at the conclusion of postoperative follow-up.

CONCLUSION

Limited data have been published on the long-term survival of corneal grafts after intraocular surgery, especially for extremely 'mature' corneal transplants. This case series demonstrates that with appropriate preoperative, intraoperative and postoperative measures, successful phacoemulsification can be performed in these cases with excellent long-term results.

Review of anaesthetic management for cataract surgery in transplant recipients

The prevalence of transplantation is on the increase worldwide. Corneal transplantation is the most common form of human donor transplantation. Transplantation of other organs and bone marrow is established treatment for various end-organ failure and many haematological conditions, respectively. Success and survival of these patients have increased with advances in immunosuppression. Unfortunately, these patients are susceptible to cataract formation as a consequence of immunosuppressive therapy and accelerated progression of several diseases. Topical anaesthesia and regional ophthalmic blocks are ideal for cataract surgery in cooperative adults. General anaesthesia may be required in children, for extremely anxious or claustrophobic adults and for complex surgery such as simultaneous cataract and corneal transplantation. The perioperative anaesthetic management of cataract surgery in a transplant recipient is no different to a standard technique in a healthy adult, but additional challenges are posed by the underlying pathology necessitating transplantation, function of the transplanted organ, physiological and pharmacological problems of allograft denervation, side-effects of immunosuppression, risk of infection and potential for rejection. This narrative review summarises optimal anaesthetic management in transplant recipients undergoing cataract surgery.

Cataract surgery and lens implantation

PURPOSE OF REVIEW

This review aims to introduce recent updates in cataract surgery and lens implantation.

RECENT FINDINGS

Compared to phacoemulsification, femtosecond laser-assisted cataract surgery (FLACS) may offer benefit for cataract patients with other complicated ocular diseases, such as corneal disease and vitreous abnormalities. Meanwhile, several types of novel intraocular lenses (IOLs) have been introduced to the market, and each of them has particular features in improving patients' visual acuity. In addition, based on a series of studies, multifocal IOL is superior to monofocal IOL when it comes to providing a better visual correction at different distances. Furthermore, a research group has introduced a new approach for cataract surgery - all laser surgery (FLACS band with nanolaser emulsification), which can effectively reduce iatrogenic trauma to the cornea. Also, a novel technique designed for children can lessen damage from cataract surgery.

SUMMARY

Based on previous studies, we summarize the new proceedings in FLACS and the indications for applying multifocal or toric IOL. In addition, we briefly introduce a new approach to cataract surgery - all laser surgery (FLACS band with nanolaser emulsification), and a less invasive surgical procedure used in pediatric cataract patients.

Femtosecond laser-assisted cataract surgery with implantation of a diffractive trifocal intraocular lens after laser in situ keratomileusis: a case report

Background

We report for the first time, a case of femtosecond laser-assisted cataract surgery (FLACS) with implantation of a diffractive trifocal intraocular lens (IOL) after laser in situ keratomileusis (LASIK).

Case presentation

A 60-year-old man underwent FLACS uneventfully 15 years after myopic LASIK. An AT Lisa tri 839MP IOL was implanted with the expectation of spectacle independence. The Haigis-L formula was chosen for calculation of the IOL power and it provided reliable results. Three months postoperatively, the uncorrected visual acuities were 0.00 logMAR for distance, 0.10 logMAR for intermediate, and 0.10 logMAR for near.

Conclusions

This case suggested that FLACS presents a feasible surgical technique for post-LASIK eyes and that implantation of trifocal IOL can achieve good visual performance in strictly selected cases after myopic LASIK.