title: Penetrating keratoplasty for pseudophakic bullous keratopathy associated with closed-loop anterior chamber intraocular lenses.
abstract: Closed-loop anterior chamber intraocular lenses (AC IOLs) are associated with a high incidence of pseudophakic bullous keratopathy (PBK). The prognosis for recovery of vision with penetrating keratoplasty and the exchange of one type of AC IOL for another remains controversial. A total of 40 consecutive patients with closed-loop AC IOLs and varying degrees of PBK underwent penetrating keratoplasty, explanation of the closed-loop AC IOL, and implantation of a flexible tripod AC IOL--all done with a uniform technique. The average follow-up study was 24 months. Average preoperative visual acuity was 20/170 (range, 20/25-hand motions) and average postoperative visual acuity was 20/44 (range, 20/20-no light perception). A total of 23 eyes (57.5%) achieved a visual acuity of 20/40 or better. Eleven eyes (27.5%) had a visual acuity of 20/200 or worse. Persistent cystoid macular edema was the most frequent cause of poor vision postoperatively (4 eyes), followed by age-related macular degeneration (3 eyes) and graft rejection (2 eyes). This is the first series documenting a good visual outcome for at least 2 years after penetrating keratoplasty and exchange of a closed-loop AC IOL for a single type of flexible tripod AC IOL.
authors.affiliation: Cornea Consultation Service, Massachusetts Eye and Ear Infirmary, Boston 02114.
authors.forename: E W
authors.initials: EW
authors.lastname: Kornmehl
authors.forename: R F
authors.initials: RF
authors.lastname: Steinert
authors.forename: M G
authors.initials: MG
authors.lastname: Odrich
authors.forename: J B
authors.initials: JB
authors.lastname: Stevens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000601:surgery; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating / Q000379:methods; D007910:Lenses, Intraocular / Q000009:adverse effects*; D008269:Macular Edema / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D014792:Visual Acuity