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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

Clinical Sciences

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.

From the Department of Ophthalmology and Visual Sciences (Dr Farjo), University of Iowa Hospitals and Clinics, Iowa City, Iowa; Department of Ophthalmology (Dr Farjo), Davis Duehr Dean, Madison, Wisconsin; Wills Eye Hospital (Dr Rhee), Philadelphia, Pennsylvania; and Department of Ophthalmology and Visual Sciences (Drs Soong, Meyer, and Sugar), Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.

Received for publication March 25, 2003;

revision received July 1, 2003; accepted July 1, 2003.

Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York (Kellogg Eye Center).

The authors do not have a financial interest in any products mentioned.

Reprints: Ayad A. Farjo, MD, Arcand Park Clinic, 3434 East Washington Avenue, Madison, Wisconsin 53704 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.