Results of Combined Penetrating Keratoplasty and Implantation of Posterior Chamber Intraocular Lenses

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Abstract

Introduction

Our purpose was to evaluate the clinical outcome in 14 patients (14 eyes) who underwent penetrating keratoplasty and scleral-fixation of an intraocular lens (IOL).

Materials and Methods

Charts of the patients who underwent combined penetrating keratoplasty and implantation of scleral-sutured posterior chamber intraocular lenses between January 2010 and January 2015 were reviewed. Gender and age of the patients, indication for surgery, pre- and post-operative best corrected visual acuity, diopter of implanted IOL, postoperative refraction, duration of follow-up and complications were recorded.

Results

The mean age of the patients was 71.2±15.0 years and the female/male ratio was 11/3. The indications for penetrating keratoplasty with scleral-fixation of an intraocular lens were pseudophakic corneal edema in 6 patients (43%), aphakic corneal edema in 2 patients (14%), trauma in 3 patients (21%), and corneal scars in 3 patients (21%). Patients with pseudophakic corneal edema underwent IOL exchange and penetrating keratoplasty. Patients with lens subluxation underwent cataract extraction and penetrating keratoplasty in the same operation session. Preoperative visual acuity was p+p+ in 2 eyes (14%), hand motion in 5 eyes (36%), finger counting in 4 eyes (28%) and 20/400 in 3 eyes (21%). The mean duration of follow-up was 14.8±8.5 months. Postoperative spectacle- corrected visual acuity of 20/200 or better was observed in 8 eyes (57%). The postoperative mean spherical equivalent was 2,53± 6,00 D and the mean cylinder was 3,78±1,66 D. At the end of follow-up, 6 corneal grafts remained clear. Graft failure was observed in 7 eyes (50%) and reccurrence of herpetic stromal keratitis was observed in 1 eye (7%). Glaucoma was observed in 9 eyes (64%) and graft failure occured as a result, in 5 of these.

Conclusions

Trans-scleral fixation of intraocular lenses combined with penetrating keratoplasty is associated with favorable visual outcomes in eyes with keratopathy and lacking posterior capsular support. However, glaucoma is an important and common complication frequently leading to graft failure.

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