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Cornea:
Clinical Sciences

Iris-Sutured Posterior Chamber Intraocular Lens Implantation During Penetrating Keratoplasty

Farjo, Ayad A. MD; Rhee, Douglas J. MD; Soong, H. Kaz MD; Meyer, Roger F. MD; Sugar, Alan MD

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Abstract

Purpose: To evaluate the clinical indications and postoperative results of iris-sutured posterior chamber intraocular lens implants performed during penetrating keratoplasty.

Methods: Medical records were retrospectively reviewed for preoperative indications and postoperative results of 342 consecutive patients (366 eyes) who underwent iris suturing of a posterior chamber intraocular lens implant during penetrating keratoplasty over a 9-year period.

Results: Mean follow-up was 36 months. The principal indications for corneal transplantation were pseudophakic and aphakic bullous keratopathy. Mean postoperative best spectacle-corrected visual acuity was better than preoperatively at all measured time points (P < 0.0001) and improved from 20/474 preoperatively to 20/85 at 1 year. Nine eyes (7.7%) with known preoperative glaucoma required escalation of therapy by medication or surgery to control the intraocular pressure. Seventy-two eyes (29%) without known preoperative glaucoma required treatment of elevated intraocular pressure. Seventy-nine eyes (28%) without known preoperative cystoid macular edema were additionally diagnosed. Mean endothelial cell counts declined throughout the study time frame. Corneal donor rejection episodes occurred in 36 (9.8%) eyes, with the majority having a single episode. Overall, 27 (7.4%) eyes had known graft failure at last follow-up. Two eyes (0.5%) were enucleated following wound disruption.

Conclusions: These long-term results of iris-sutured posterior chamber intraocular lens implants performed during penetrating keratoplasty suggest acceptable visual acuity, graft survival, and complication rates. They are similar to published retrospective and prospective results of flexible open-loop anterior chamber and transsclerally-sutured posterior chamber intraocular lens implants placed during penetrating keratoplasty.

Corneal edema following cataract surgery remains a significant indication for penetrating keratoplasty 1–3 in spite of decreased usage of closed-loop anterior chamber intraocular lenses (ACIOLs) and other lens types associated with pseudophakic bullous keratopathy. During penetrating keratoplasty (PKP), it is generally advantageous to leave the operated eye pseudophakic, given the optical advantages of intraocular lenses (IOLs). Additionally, the typical patient requiring this procedure is often older and poorly tolerates contact lenses and aphakia. Clinical experience in the 1980s 4–11 suggested that closed-loop ACIOLs and unstable IOLs should be removed at the time of PKP. Frequently, the absence of posterior capsular support complicates intraocular lens implantation during PKP. In this circumstance, the surgical options for pseudophakia include (1) placement of a flexible, open-loop ACIOL in the anterior chamber angle, (2) placement of a posterior chamber intraocular lens (PCIOL) with iris-fixation sutures, or (3) placement of a PCIOL with transscleral-fixation sutures. There is currently no consensus as to which of these methods is optimal; however, the status of the anterior chamber, especially in regard to angle structures and the iris, are important in the decision-making process. We report our long-term results with iris-sutured PCIOLs at the time of penetrating keratoplasty.

© 2004 Lippincott Williams & Wilkins, Inc.

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