• Cataract/Anterior Segment, Cornea/External Disease

    Review of: Survival of the fittest: Phacoemulsification outcomes in four corneal transplants by Dr Ramon Castroviejo

    Franco J, Luis J, Rahim S, et al. British Journal of Ophthalmology, August 2021

    Records from 3 patients who had a penetrating keratoplasty (PKP) performed by Dr. Ramon Castroviejo were evaluated after undergoing cataract surgery some 45 years after corneal transplantation.

    Study design

    This is a retrospective case series reporting the postoperative phacoemulsification outcomes in 4 eyes of 3 patients who had a penetrating keratoplasty (PKP) performed at least 45 years ago. Surgical techniques included a scleral tunnel, “soft shell” viscoelastic technique, and a “divide and conquer” approach; all IOLs were placed in the capsular bag. Patient records were reviewed for endothelial cell count, corneal clarity, central corneal thickness (CCT), and best-corrected visual acuity.


    In all 4 eyes, no instances of graft failure were seen during the postoperative follow-up period following cataract surgery (range: 17–76 months). At the conclusion of the study interval, postoperative vision remained better than or similar to preoperative vision. There were no consequential changes in CCT, and postoperative endothelial cell loss ranged from 5% to 14% in 3 of the 4 corneas, with the fourth cornea thought to measure an erroneous increase in cell density (preoperative values were 566, 1170, 902, and 592 cells/mm2). Preoperative anterior chamber depth was >3.5 mm in all cases.


    This is a limited case series of only 4 corneas, but it is the first report of post-phacoemulsification outcomes in eyes with corneal transplants performed 45+ years ago.

    Clinical significance

    The majority of corneal grafts fail due to progressive endothelial cell loss within 30 years of transplantation, but for those that don’t, cataract surgery can be successful almost half a century after corneal transplantation.