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Survival of the fittest: phacoemulsification outcomes in four corneal transplants by Dr Ramon Castroviejo
  1. Jovany Jeomar Franco1,
  2. Jose Luis Reyes Luis2,
  3. Salma Rahim3,
  4. Stephen Greenstein4,
  5. Roberto Pineda2
  1. 1 Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  3. 3 Ophthalmology, Makkah Eye Complex, Khartoum, Sudan
  4. 4 The Cornea and Laser Eye Institute, Teaneck, New Jersey, USA
  1. Correspondence to Roberto Pineda, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA; rpineda4{at}


Aim To evaluate and report the outcomes following phacoemulsification on four eyes, 45 years or more after corneal transplantation.

Methods A retrospective case series of four eyes in three patients (P1, P2, P3), undergoing phacoemulsification at least 45 years after corneal transplantation by Dr Ramon Castroviejo. Corneal graft survival outcome measures included central corneal thickness (CCT), best-corrected visual acuity (BCVA), corneal clarity and endothelial cell count (ECC).

Results Phacoemulsification was successfully completed in all four cases with no instances of graft failure during the postoperative follow-up period, which ranged from 17 months to 76 months. At the conclusion of the follow-up period, all four grafts remained clear, and BCVA remained better than or similar to preoperative values. Long-term follow-up revealed no meaningful changes in CCT after phacoemulsification. All but one case experienced a decrease in ECC, with ECC values in the four cases ranging from 538 cells/mm2 to 1436 cells/mm2 at the conclusion of postoperative follow-up.

Conclusion Limited data have been published on the long-term survival of corneal grafts after intraocular surgery, especially for extremely ‘mature’ corneal transplants. This case series demonstrates that with appropriate preoperative, intraoperative and postoperative measures, successful phacoemulsification can be performed in these cases with excellent long-term results.

  • Treatment Surgery
  • Cornea
  • Lens and zonules
  • Immunology

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  • Contributors JJF and JLRL helped in the revision of data, writing and preparation of the manuscript. SG and SR helped in planning, data collection and writing of the manuscript. RP helped in planning, data collection, and revision and preparation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was examined by the Institutional Review Board and deemed exempt from review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data availability not applicable as no data sets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information.

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