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ABSTRACT
The results of 36 patients who underwent penetrating keratoplasty with transscleral fixation of a posterior chamber intraocular lens are reviewed. A 13.75millimeter "Reviens," which has the configuration of an open-loop anterior chamber lens, was used in all of the cases and gave good stability in the ciliary sulcus. The 10-0 Prolene sutures used to secure the implants were burrowed through the sclera and exited sufficiently far from the limbus to be adequately covered by Tenon's capsule and conjunctiva. No sutures eroded through the conjunctiva or needed to be removed. Two grafts became opaque, one from rejection and the other from uncontrolled glaucoma. No vitreous hemorrhage or retinal detachment occurred. Ten patients (27.8%) had cystoid macular edema diagnosed either before or after surgery; three had age-related macular degeneration; and two had traumatic macular scars. Sixteen eyes (44.4%) had final visual acuities of 20/40 or better and 25 (69.4%) saw 20/200 or better. Mean follow up was 16.8 months (range, 9 to 36 months).
Pseudophakie bullous keratopathy, often associated with closed-loop anterior chamber intraocular lenses (AC-IOLs), is now the commonest indication for penetrating keratoplasty (PKP) in the United States.1 It is usually recommended that closed-loop IOLs and iris-plane IOLs be removed during PKP,2-6 thus rendering the patient aphakic. In our practice, many grafts are also performed on aphakic patients and in trauma cases in which the lens is subluxed or insufficient capsule remains for adequate support of a posterior chamber intraocular lens (PC-IOL).
It is generally accepted that implanting an IOL is the optimal method of correcting aphakia. In PKP, the debate continues concerning the best way of correcting aphakia. Some authors recommend implanting or exchanging an AC-IOL,2·3·513 while others recommend implanting a PC-IOL, either sutured to the iris2·14"20 or transsclerally fixated.21"25 Many of our trauma cases have either associated angle-damage that precludes insertion of an AC-IOL or damage to the iris that prevents iris fixation.
Our method of correcting aphakia in patients undergoing PKP is to transsclerally fixate an IOL into the posterior chamber. Most surgeons use a "J"- or "C'-type haptic,26 but our preference is to use a "Reviens" IOL (Domilens, Lyon, France) (Fig 1). This lens has the configuration of an open-loop AC-IOL: the optic is biconvex with "Z'-shaped, step-vaulted haptics...