Implantation of Kelman-style, open-loop anterior chamber lenses during keratoplasty for aphakic and pseudophakic bullous keratopathy. A comparison with iris-sutured posterior chamber lenses.
The clinical and specular microscopic results of 40 cases (39 patients) of penetrating keratoplasty during which a Kelman-style anterior chamber intraocular lens was implanted were reviewed retrospectively. Thirty-one pseudophakic eyes received an intraocular lens exchange and nine aphakic eyes received a secondary intraocular lens. Postoperative follow-up averaged 24.5 months (range, 3 to 51 months). At 1, 2, and 3 years after keratoplasty, 39.3%, 63.2%, and 63.6% of eyes, respectively, had visual acuities of 20/40 or better. Ninety-five percent of the grafts remained clear. Causes of poor postoperative visual acuity included cystoid macular edema (32.5%), new glaucoma (22.5%), and age-related macular degeneration (10.0%). Other causes were endothelial rejection leading to graft failure, corneal ulceration, and retinal detachment. Corneal endothelial cell loss by specular microscopy was 11.5% at 1 years, 21.3% at 2 years, and 25.0% at 3 years. These results were compared with cell loss associated with iris-sutured posterior chamber lenses in penetrating keratoplasty. Visual outcomes and complication rates were similar between these two methods; however, the endothelial attrition at 1 and 2 years for the sutured posterior chamber lens was greater than that of the Kelman anterior chamber lens.
Hassan
T S
TS
Department of Ophthalmology, W.K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor.
Soong
H K
HK
Sugar
A
A
Meyer
R F
RF
D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000601:surgery*; D001035:Aphakia / Q000601:surgery*; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D004728:Endothelium, Corneal / Q000378:metabolism; D006801:Humans; D007498:Iris / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects; D007910:Lenses, Intraocular; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D014792:Visual Acuity