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Purpose . To report outcomes of graft refractive surgery (GRS) along with clear-cornea phacoemulsification and intraocular lens (IOL) implantation in penetrating keratoplasty (PKP) eyes.  Methods . Fourteen eyes of 13 patients who had received PKP underwent simultaneous GRS (relaxing incisions with or without counter-quadrant compression sutures) and clear-cornea phacoemulsification with IOL implantation. To calculate IOL power, preoperative keratometry readings and the SRK-T formula were used.  Results . Mean patient age and follow-up period were 50.5 ± 14.4 years and 14.6 ± 7.1 months, respectively. A significant increase was observed in best spectacle-corrected visual acuity (from 0.55 ± 0.18 logMAR to 0.33 ± 0.18 logMAR,  P  = 0.001). There was a significant decrease in vector keratometric astigmatism by 6.22 D ( P  = 0.03). Spherical equivalent refraction was reduced from −3.31 ± 3.96 D to −1.69 ± 2.38 D ( P  = 0.02) which did not significantly differ from the target refraction (−0.76 ± 0.14 D,  P  = 0.20). No complications developed and all the grafts remained clear at the final examination.  Conclusion . Simultaneous phacoemulsification and GRS is a safe and effective method to address post-PKP astigmatism and lens opacity. IOL power can be calculated from preoperative keratometry readings with an acceptable accuracy. However, patients should be informed about the possibility of high refractive errors postoperatively.

Simultaneous Phacoemulsification and Graft Refractive Surgery in Penetrating Keratoplasty Eyes