Early cataract after full corneal graft

[PhilLer]

Dear all,

I'm 43 years old and I got a full corneal graft in my right eyes in 1999 July.
This year, a surgeon detected in my right eyes an early cataract.
Does anybody have the same observation ?
It looks that cataract is accelerated in my right eyes due to full corneal graft transplantation 22 years earlier (because of the use of corticoides to avoid graft rejection).
Is it possible to operate cataract with a corneal graft that only has around 500 endothelial cells/mm2 (risk of endothelial decompensation)?

Best regards,
Philippe

[Anne Klepacz]

Thank you for all your interesting posts in the last couple of days!
Corneal graft surgery does sometimes mean cataracts develop earlier than usual. I was also first told I had early cataracts around 20 years after surgery (I had grafts in both eyes). In my case they stayed mild for nearly ten years and didn't interfere with my vision, so hopefully you may find the same. I only had to have one operated after I'd had a regraft in one eye (it accelerated because of all the post graft steroids). That worked very well, though obviously I had a very healthy new graft in that eye.
I'm now soon to have the other cataract operated, in the eye with a 32 yr old graft. A few years ago, I was told the endothelial cell count was low, but the results were different depending on how it was measured and I was told these counts weren't very reliable. Another cell count on a new machine last week gave very much higher results, so I'm now thoroughly confused! Anyway, the short answer is that it is possible. My surgery carries a risk of the graft failing, but if that happens, a new transplant of just the endothelial layer may well be possible. As ever, it's a question of weighing up the risks and benefits. As long as the cataracts weren't really affecting my vision, I was more than happy to leave well alone!

[PhilLer]

Hi Anne,

I thank you very much for your very kind response and sharing your story! I'm happy to read that somebody else has the same problem. I'm more relaxed now. I hope the best for your next cataract operation! How old are you now and at what age was your cataract firstly observed?

These last days, after visiting two surgeons (and discovering that I may be operated again soon for a full corneal graft on my right eyes that has an early cataract due to loss acuity), I took some time to read some papers on eyes and cornea. I'm a research scientist focusing on interfacial physico-chemical processes.

Best regards,
Philippe

[gsward]

I already had signs of an early cataract before needing a graft. This was due to damage to the corneal following hydrops. However, 18 months after the graft the cataract had advanced to the point that vision was worse than it had ever been. So it was time for cataract surgery. It does present more of a surgical challenge and can upset the graft, but currently, vision is better than it ever has been in my life as my inherent longsightedness has been corrected too.

Clearly, every case is different and you need to discuss all the risks with your surgeon.

[PhilLer]

Hi Gsward,

thank you so much for your positive news regarding your sight and your advice for my eyes.
What age were you when they detect your cataract?
Cataract in your case was probably worst because of steroid use after corneal transplant.
Did you have penetrating keratoplasty or deep anterior lamellar keratoplasty?

Best regards,
Philippe

[gsward]

About 55. I had noticed it and it was quite a few (5 maybe) before I noticed any reduction in vision. I had penetrating keratoplasty. You are absolutely right about the steriod use. It cannot be avoided after a graft as you need to prevent rejection and the side effect of precipitating a cataract doesn't affect everyone.

If things don't work out as you hoped, at least you know you made a decision on the best advice and your understanding of the risks.

[PhilLer]

J Cataract Refract Surg. 1997 May;23(4):562-4. doi: 10.1016/s0886-3350(97)80214-3.
Cataract formation after penetrating keratoplasty
V M Rathi 1, M Krishnamachary, S Gupta
Affiliations expand
PMID: 9209992 DOI: 10.1016/s0886-3350(97)80214-3
Abstract
Purpose: To assess the incidence and risk factors for developing cataract after penetrating keratoplasty (PKP).

Setting: L.V. Prasad Eye Institute, Hyderabad, India.

Methods: This retrospective analysis of 251 phakic patients who had PKP between 1987 and 1994 assessed the incidence of and risk factors for cataract formation. Patients were assigned to one of two groups: Group 1 (n = 96), patients with keratoconus and corneal dystrophy; Group 2 (n = 88), patients with corneal scar and adherent leucoma. Preoperative, intraoperative, and postoperative lens details were noted. Data on intraoperative iris procedures (excess manipulation, pupilloplasty, synechiolysis, peripheral iridectomy) and postoperative topical steroid usage were assessed.

Results: Sixty-seven patients were excluded because of incomplete lens status data. Of the remaining 184 patients, 45 (24.45%) developed cataract. Most cataracts (n = 31) developed within the first year of surgery. The incidence of cataract was significantly higher in Group 2 (n = 29) than in Group 1 (n = 16) (P = .0102). There was no significant between-group difference in mean steroid dose (P = .7064); however, the mean dose was significantly higher in eyes with cataracts (563 +/- 234 units) than in those without (479 +/- 127 units) (P = .0352). In Group 2, 9 of 20 patients who had synechiolysis, 1 of 3 who had pupilloplasty, and 2 of 5 who had peripheral iridectomy developed cataract. In Group 1, no patient had iris-related procedures.

Conclusion: Excessive steroid use and intraoperative iris manipulations are major risk factors for cataract formation after PKP.

https://pubmed.ncbi.nlm.nih.gov/9209992/