When we perform cataract surgery in an eye with a previous corneal transplant, we must do things a little differently to ensure success and a good visual outcome. In this case of a full-thickness penetrating keratoplasty (PKP), the eye has healed for more than a year and almost all of the sutures have been removed. There appear to be two partial sutures left in the eye and the patient has achieved a stable corneal topography which shows a higher degree of regular astigmatism. The corneal endothelial cell count is still low in these eyes since significant cell loss occurs during the harvesting, processing, and surgical transplantation process. We must be cautious to avoid further corneal endothelial cell loss. Our guest surgeon does a great job with this tough case.
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