Cataract surgery in an eye with a prior corneal transplant is more difficult and there are challenges which can alter the post-op visual outcome. The first issue is determining the appropriate IOL power estimation. The new cornea is likely to be at least somewhat irregular and in this case there is also a long axial length from high myopia. Aiming for a post-op myopic outcome of at least a diopter or two is a good idea. Remember that there is always a benefit of mild myopia but almost never a benefit to post-op hyperopia. This patient can go back to using a rigid contact lens after healing from the cataract surgery in order to achieve the best vision.
We can also measure the health and status of the donor cornea tissue by doing an endothelial cell count or checking the corneal pachymetry. Having a pachymetry of less than 600 microns is a good prognostic sign, whereas pachymetry over 650 microns means that there is a high risk of corneal failure after even a perfectly-performed cataract surgery. When performing cataract surgery, using a good dispersive viscoelastic, operating away from the corneal endothelium, and employing low phaco energy / fluids, will all help in delivering a clear cornea after surgery.
During surgery we need to use lower infusion pressure to avoid placing stress on the graft-host junction in the corneal tissue. Finally, checking the graft-host junction at the end of surgery can help to detect any leakage which could require a suture. In the post-op period, be sure to use a sufficient steroid regimen to quell inflammation and lessen the risk of graft failure or rejection.
Our patient had a great result with a clear cornea on post-op day #1. We also elected to place a single 10-0 nylon suture to close the phaco incision.
Click below to learn how to do cataract surgery after a corneal transplant: