Role of Ultrasound Biomicroscopy in Predicting Intraoperative Surgical Strategies in Penetrating Keratoplasty with Cataract Extraction and IOL Implantation

Background: Penetrating Keratoplasty with cataract extraction and Intraocular Lens (IOL) implantation (Triple procedure) is very challenging procedure because in cases of Opaque cornea, status of anterior segment is difficult to predict that can lead to intraoperative surprises. If not managed properly, these can severely affect visual outcome. To avoid this, we performed Ultrasound Biomicroscopy (UBM) preoperatively for detailed analysis of anterior segment structures and associated pathologies and later compared it with intraoperative findings to judge predictive accuracy of UBM in guiding surgical strategies, decision making and modifications intraoperatively. Methods and findings: 20 eyes of 20 patients with different grades of corneal opacities like simple corneal opacities (6 eyes) or adherent leucoma (7 eyes) or anterior staphyloma (7 eyes) that underwent Triple procedure (Penetrating Keratoplasty+ cataract extraction+ IOL implantation) were evaluated preoperatively by UBM and the findings were compared intraoperatively to find predictive accuracy of UBM. Extent and depth of corneal lesions, corneal thickness, anterior chamber depth, type, position and extent of synechiae, pupillary membrane and status of lens and capsule were assessed. Scan was performed to visualize any posterior segment pathology and to find Axial Length (AL). Keratometry readings of other eye were taken to calculate IOL power for implantation. Preoperative UBM findings when co-related intraoperatively was found to be accurate in 71.42%- 100% parameters and accordingly these cases underwent penetrating Keratoplasty with other modifications like Iridectomy, Membranectomy, Synechiolysis, iris reconstruction, Trabeculectomy, cataract extraction and IOL implantation. Conclusion: In cataract coexisting with corneal pathologies, UBM is Best and reliable guide in predicting and preplanning of surgical strategies for best visual outcomes.