title: Preoperative ultrasound biomicroscopy to assess ease of haptic removal before penetrating keratoplasty combined with lens exchange.
abstract: OBJECTIVE
  To evaluate a method of assessing anterior chamber intraocular lens (IOL) haptics before combined penetrating keratoplasty and IOL exchange in eyes with poor corneal clarity resulting from pseudophakic bullous keratopathy (PBK).
  
  
  METHODS
  Department of Ophthalmology, Toronto Hospital, Ontario, Canada.
  
  
  METHODS
  Twelve eyes (25 haptics) with PBK were studied using ultrasound biomicroscopy (UBM). The degree of haptic encasement was graded. The result was compared with the degree of difficulty and the complications encountered in removing the IOL at the time of surgery. The surgeons were masked as to the UBM results.
  
  
  RESULTS
  All haptics were easily visualized with UBM, with 23 in the angle and 2 passing through a peripheral iridectomy. On UBM, 9 haptics were noted to lie free in the angle, and 16 were encased by fibrotic tissue. Eight were covered by less than 100 microns and 8 by more than 100 microns of tissue. Calculations using Kappa statistics found a strong predictive value for the UBM in identifying the presence or absence of fibrotic encasement and degree of difficulty in removing the anterior chamber IOL haptics. Ultrasound biomicroscopy also allowed assessment of the adjacent angle for synechias.
  
  
  CONCLUSIONS
  Ultrasound biomicroscopy provides an alternative method for evaluating anterior chamber IOL haptics when gonioscopy is not possible because of corneal opacity. This method allows the surgeon to predict preoperatively the degree of difficulty that will be encountered in explanting the IOL.
authors.affiliation: Department of Ophthalmology, Toronto Hospital, Ontario, Canada.
authors.forename: S S
authors.initials: SS
authors.lastname: Rutnin
authors.forename: C J
authors.initials: CJ
authors.lastname: Pavlin
authors.forename: A R
authors.initials: AR
authors.lastname: Slomovic
authors.forename: J
authors.initials: J
authors.lastname: Kwartz
authors.forename: D S
authors.initials: DS
authors.lastname: Rootman
mesh_terms: D000867:Anterior Chamber / Q000000981:diagnostic imaging* / Q000601:surgery; D003316:Corneal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D005355:Fibrosis / Q000000981:diagnostic imaging; D006801:Humans; D054018:Lasers, Excimer; D007910:Lenses, Intraocular; D018903:Photorefractive Keratectomy; D011300:Preoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D014463:Ultrasonography