Cataract progression and treatment following posterior lamellar keratoplasty

Purpose: To describe the development and treatment of cataracts following posterior lamellar keratoplasty (PLK) in phakic eyes with Fuchs' endothelial dystrophy. Setting. Price Vision Group, Indianapolis, Indiana, USA. Methods: A retrospective chart review was performed on 47 PLK cases performed by a single surgeon between June 2001 and December 2002 in a tertiary care setting. Four of the eyes were phakic at the time of surgery. The PLK procedure consisted of dissecting a stromal pocket across the cornea and excising a central button. Then a posterior lamellar donor button, consisting of posterior stroma, Descemet's membrane, and endothelium, was transplanted without suture fixation. Results: All 4 phakic eyes that were treated with PLK developed a cataract within 1 year of transplant. The cataracts were removed with phacoemulsification through a clear corneal incision, and intraocular lenses (IOLs) were placed in all 4 eyes with no adverse effect on graft clarity. Conclusions: It is preferable to perform PLK in pseudophakic rather than phakic eyes because the manipulation involved in the procedure can induce cataract formation. Cataract surgery with placement of an IOL can be successfully performed following PLK.