Abstract

Introduction: It is known that simultaneous penetrating keratoplasty, cataract removal and intraocular lens implantation are always a big challenge to a surgeon, especially in developing countries such as Bosnia and Herzegovina. In these cases there is always a higher rate of different kind of intraoperative complications. Phacoemulsification after penetrating keratoplasty especially in older people may cause significant endothelial injury and also could affect long term graft survival. Aim: The aim of this report is to describe one of these challenging cases and the possible ways to manage them in developing countries. Case report: In this paper we report a case of a 46 year-old female patient, with a cataract on her right eye with a central corneal leukoma. She reported that when she was 6 years old, she had an eye injury with corn leaf. At the age of 10 year she reported that she had another injury of the same eye with a glass. She reported that she wasn’t seeing quite good after that. Three years ago she had a transplantation of amniotic membrane due ulcer on the same eye. She reported also that even after this procedure she wasn’t seeing quite good. Now she was admitted to hospital for a triple surgical procedure. At that moment patient has been ophthalmological examined (visual acuity testing, biomicroscopy, tonometry, ultrasound of both eyes with biometry and ophthalmoscopy). At the day of admission to the hospital on slit lamp we found central corneal leukoma, occlusion of pupil and complicated cataract. Before surgery her Uncorrected distance visual acuity (UDVA) on her left eye was light perception. A combined procedure of penetrating keratoplasty (PKP), open-sky cataract extraction, and intraocular lens (IOL) implantation was planned. Thirty days after surgery her visual acuity was 0,5 without correction. It is concluded that cataract surgery in patients after keratoplasty is more complicated. Conclusion: Therefore, these patients should be managed with utmost care and operated by an experienced surgeon.

Key words: open sky, keratoplasty, phacoemulsification.