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Long-Term Outcome of Combined Penetrating Keratoplasty With Scleral-Sutured Posterior Chamber Intraocular Lens Implantation

Malta, João Baptista MD; Banitt, Michael MHA, MD; Musch, David C PhD, MPH; Sugar, Alan MD; Mian, Shahzad I MD; Soong, H Kaz MD

doi: 10.1097/ICO.0b013e31819bc31f
Clinical Science

Purpose: To evaluate the long-term outcomes of combined penetrating keratoplasty (PKP) with scleral-sutured posterior chamber intraocular lens (PC-IOL) implantation.

Methods: Medical records from patients with aphakic and pseudophakic bullous keratopathy were retrospectively reviewed for preoperative indications and postoperative results of 105 consecutive patients (105 eyes) who underwent combined PKP and scleral-sutured PC-IOL implantation over a 13-year period. Main outcomes measures were graft survival rate, visual acuity, and intraoperative and postoperative complications.

Results: The principal indications for PKP were pseudophakic and aphakic corneal edema. Graft survival rates were 97% at 1 year, 91% at 2 years, 75% at 5 years, and 68% at 7 years. Mean postoperative follow-up was 44.8 ± 37.0 months (range 1-156). The best-corrected visual acuity improved at least 1 line on the Snellen chart in 59.0% of the patients, with 42.9% of the eyes achieving acuities of 20/100 or better. Postoperative complications included new glaucoma in 21.4%, worsening of pre-existing glaucoma in 28.6%, cystoid macular edema in 17%, infectious endophthalmitis in 3.8%, and intraocular lens dislocation in 1.9%. No intraoperative complications were encountered.

Conclusions: PKP combined with scleral-sutured PC-IOL implantation can achieve acceptable outcomes with a low rate of intraocular lens dislocation, but may be associated with significant short and long-term complications.

From the *Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Department of Ophthalmology, Division of Cornea and External Disease, Santa Casa de São Paulo, São Paulo, Brazil; and ‡Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.

Received for publication July 15, 2008; revision received October 29, 2008; accepted October 29, 2008.

Supported in part by Fight for Sight (GA07006), Research to Prevent Blindness, and Michigan Institute for Clinical and Health Research New Pilot Clinical Trial Training Grant

Reprints: H. Kaz Soong, MD, W.K. Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI, 48105 (e-mail:

Copyright © 2009 Wolters Kluwer Health, Inc. All rights reserved.