title: Penetrating keratoplasty and transscleral fixation of posterior chamber lens.
abstract: We reviewed the outcome in 115 patients who underwent penetrating keratoplasty and transscleral fixation of a posterior chamber lens. One patient died soon after surgical procedures, and nine patients were lost to follow-up, leaving a cohort of 105 patients. Mean follow-up time was 26.8 months (range, six to 43 months). Visual acuity of 20/40 or better was found in 29 patients (27.6%) and 20/50 to 20/200 in 37 patients (35.2%). Reasons for poor visual outcome included cystoid macular edema in ten patients (9.5%), age-related macular degeneration in six patients (5.7%), and retinal detachment in four patients (3.8%). None of the patients developed lens decentration. There were no instances of hyphema and only one patient had a perioperative limited suprachoroidal hemorrhage. New-onset increase in intraocular pressure developed in 20 of 66 patients (30.3%). Analysis of the 39 patients with preoperative increase in intraocular pressure that required medical treatment demonstrated an improvement in 13 patients (33.3%), worsening in 12 patients (30.8%), and unchanged status in 14 patients (35.9%). The exposed haptic suture was covered by using one of the following three alternative methods: a conjunctival flap, a scleral flap, or a corneal tissue button. Exposure of the haptic suture through the conjunctiva was a complication in 21 patients (20%). Of these 16 (76.1%) occurred in the group with a conjunctival covering, five (23.8%) occurred in the group with a scleral flap, and none occurred in the corneal tissue button group. This study demonstrated that transscleral fixation of a posterior chamber lens is a viable option in the treatment of patients undergoing penetrating keratoplasty and intraocular lens implantation with absent capsular support.
authors.affiliation: Department of Ophthalmology, University of Minnesota, Minneapolis 55455-0501.
authors.forename: E J
authors.initials: EJ
authors.lastname: Holland
authors.forename: S M
authors.initials: SM
authors.lastname: Daya
authors.forename: A
authors.initials: A
authors.lastname: Evangelista
authors.forename: J M
authors.initials: JM
authors.lastname: Ketcham
authors.forename: A J
authors.initials: AJ
authors.lastname: Lubniewski
authors.forename: D J
authors.initials: DJ
authors.lastname: Doughman
authors.forename: S S
authors.initials: SS
authors.lastname: Lane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012590:Sclera / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity