A randomized trial of intraocular lens fixation techniques with penetrating keratoplasty.
OBJECTIVE
Pseudophakic corneal edema is the principal indication for penetrating keratoplasty in the United States. Currently, three techniques of intraocular lens (IOL) fixation during penetrating keratoplasty for this condition are commonly used--flexible anterior chamber IOL (AC IOL) implantation, iris suture fixation of a posterior chamber IOL (PC IOL), and transscleral suture fixation of a PC IOL. This study represents the first prospective, randomized comparison of these three techniques.


METHODS
One hundred seventy-six consecutive patients with pseudophakic corneal edema who underwent penetrating keratoplasty with IOL exchange were randomized to one of the three implantation techniques. Standardized evaluations were performed at baseline and at 6, 12, and 18 months postoperatively. Life-table analysis provided cumulative risk estimates for specific complications.


RESULTS
Randomization produced comparable groups at baseline. The cumulative risk of macular edema was significantly less for the iris fixation cohort than for either the AC IOL or scleral fixation group. A complications index was constructed based on the major adverse outcomes of glaucoma escalation, cystoid macular edema, IOL dislocation, and graft failure. A significantly lower risk of complication was found for iris compared with scleral fixation of PC IOLs.


CONCLUSIONS
The authors conclude that transscleral fixation of the PC IOL at the time of penetrating keratoplasty for pseudophakic corneal edema is associated with a greater risk of adverse outcome than iris fixation of a PC IOL.
Schein
O D
OD
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD.
Kenyon
K R
KR
Steinert
R F
RF
Verdier
D D
DD
Waring
G O
GO
Stamler
J F
JF
Seabrook
S
S
Vitale
S
S
D000368:Aged; D000867:Anterior Chamber / Q000601:surgery; D002387:Cataract Extraction; D015715:Corneal Edema / Q000601:surgery*; D005260:Female; D006801:Humans; D007498:Iris / Q000601:surgery; D015948:Keratoplasty, Penetrating; D007910:Lenses, Intraocular / Q000009:adverse effects*; D015993:Life Tables; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D012590:Sclera / Q000601:surgery; D013536:Suture Techniques / Q000009:adverse effects*