[Perforating keratoplasty in pseudophakia]

Histopathologic findings in a transsclerally sutured posterior chamber intraocular lens

A 77-year-old woman had penetrating keratoplasty (PKP), removal of an anterior chamber intraocular lens (IOL), and implantation of a transsclerally sutured posterior chamber IOL for painful pseudophakic bullous keratopathy. Postoperatively, preexisting anterior synechias led to painful secondary angle-closure glaucoma and the eye was enucleated 8 months after the PKP. Light microscopy of the eye revealed that the haptics of the IOL were surrounded by a variably dense fibrous membrane consisting of connective tissue and fibroblasts. In some areas, the haptics had eroded into the superficial stroma of the ciliary body. Except for rare foreign-body giant cells, no inflammatory cells were present near the haptics. This case illustrates that haptics of transsclerally sutured posterior chamber IOLs may be stabilized by fibrous membranes and/or by erosion into the ciliary body relatively soon after implantation. This should be considered if surgical centration, removal, or exchange of such a lens is planned.

Complications of sulcus-supported intraocular lenses with iris sutures, implanted during penetrating keratoplasty after intracapsular cataract extraction

In a retrospective study, the authors analyzed visual results and postoperative complications in a series of 14 consecutive patients who had undergone penetrating keratoplasty and implantation of a posterior chamber intraocular lens (PC IOL) in the absence of the posterior capsule. Seven patients suffered from aphakic bullous keratopathy and seven from pseudophakic bullous keratopathy. Postoperative follow-up was 7.6 months on the average. Best-corrected postoperative visual acuity was 20/60 or better in four cases and 20/200 or better in eight. Glaucoma was present before surgery in four eyes, which persisted in all cases and developed in four new cases. Results of gonioscopic examination showed the postoperative development of goniosynechiae in four eyes. Pseudophakodonesis of various extent was present in ten eyes. Preoperatively, cystoid macular edema was diagnosed angiographically in one case. It did not improve after surgery and was seen in three additional eyes postoperatively. Causes for postoperative visual acuity lower than 20/200 were cystoid macular edema in three cases, graft rejection in one case, central retinal scar in one case, and optic nerve atrophy in one case. A distortion of the pupil was seen in three eyes in miosis and in four additional eyes in mydriasis. Corneal thickness as well as anterior chamber depth were within normal limits. Fluorophotometric evaluation of the blood-aqueous barrier showed values comparable with those obtained after intracapsular cataract extraction and implantation of an iris-fixated IOL. Despite the relatively good visual results, the high postoperative incidence of cystoid macular edema and/or glaucoma may discourage the use of this technique.