outcomes of combined penetrating keratoplasty and cataract extraction by extracapsular extraction versus phacoemulsification

purpose: to assess the results of combined penetrating keratoplasty and cataract extraction by extracapsular extraction versus phacoemulsification and to compare outcomes and complications. methods: in this interventional retrospective study, 76 eyes that had undergone triple surgery were included. cataract surgery was done in two different methods of extracapsular extraction and phacoemulsification. in the extracapsular group, intraocular lens was inserted in the ciliary sulcus however in the phacoemulsification group, the intraocular lens was fixed within the capsular bag. outcomes were compared with respect to uncorrected visual acuity, best spectacle corrected visual acuity, refractive error, keratometric readings, graft clarity and intra and postoperative complications. results: overall, 76 eyes were included in this study. mean patient age was 61.4±14.2 years and mean follow up period was 61.4±37.2 months. mean preoperative best spectacle corrected visual acuity was 1.40±0.68 log mar which increased to 0.44±0.33 log mar (p<0.001). mean preoperative spherical equivalent refractive error was -2.40±1.5 diopter which had a significant difference with target refractive error (-0.73±0.29 diopter) (p=0.004). the study subgroups (phacoemulsification and extracapsular extraction) were comparable in terms of graft survival and time between penetrating keratoplasty and graft rejection. however the phacoemulsification subgroup had better best spectacle corrected visual acuity, lower refractive error and less complications including high intraocular pressure and posterior capsular opacification. conclusion: simultaneous penetrating keratoplasty, cataract extraction, and intraocular lens insertion is a safe and effective method. phacoemulsification is superior to extracapsular cataract surgery when combined penetrating keratoplasty and cataract surgery is indicated.