When patients who are being considered candidates for endothelial keratoplasty (EK) also have a cataract, the first issue is to determine whether the surgeries should be done sequentially or simultaneously. Then, if the decision is to proceed with combined EK/cataract surgery, surgeons will need to modify their usual cataract technique to assure the safety and success of the grafting procedure, said Jessica B. Ciralsky, MD.
“It may be challenging to differentiate the cause of visual loss in a patient with both cataract and corneal disease, and perhaps the patient may not need both surgeries,” said Dr. Ciralsky, assistant professor of ophthalmology, Weill Cornell Medical College, New York.
“Alternatively, a patient may need keratoplasty and cataract surgery, but may have findings that make it difficult or dangerous to perform them both at a single session,” she said.
For example, if the cornea is so cloudy that intraocular visualization is poor, it may be necessary to wait to perform the cataract surgery. Or cataract surgery alone may be performed first if there are complicating factors, such as intraoperative floppy iris syndrome, hyperopia with a small anterior chamber, or zonular instability.
“The last thing you want is vitreous in the anterior chamber or an anterior capsule tear that extends when air is injected during the keratoplasty,” Dr. Ciralsky said.