title: Visual and clinical outcomes of explantation versus preservation of the intraocular lens during keratoprosthesis implantation.
abstract: OBJECTIVE
  To compare the short-term visual and clinical outcomes of explantation versus preservation of a posterior chamber intraocular lens (PC IOL) during keratoprosthesis implantation.
  
  
  METHODS
  Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
  
  
  METHODS
  Comparative case series.
  
  
  METHODS
  This study comprised patients who had implantation of an aphakic or a pseudophakic Boston type I keratoprosthesis based on their lenticular status. Only adult patients who were pseudophakic with a PC IOL at the time of surgery and who had at least 1 year of follow-up were included. The postoperative refractive error, uncorrected and corrected visual acuities, and intraoperative and postoperative complications were analyzed.
  
  
  RESULTS
  Fifteen patients with an unstable PC IOL had aphakic keratoprosthesis implantation with IOL explantation, and 10 patients had implantation of a pseudophakic keratoprosthesis. The postoperative best-ever visual acuity and magnitude of visual acuity improvement were comparable in the 2 groups. The mean postoperative spherical equivalent refractive error was significantly better in the aphakic group (-0.66 diopter [D] ± 1.59 [SD]) than in the pseudophakic group (-3.25 ± 3.20 D) (P=.04). The rate of postoperative complications in the 2 groups was low (P>.05).
  
  
  CONCLUSIONS
  In this small short-term study, refractive outcomes were better in aphakic patients than in patients who were left pseudophakic. Although not frequent, posterior segment complications after IOL explantation might necessitate further surgeries and cause decreased visual acuity during long-term follow-up in the aphakic group.
authors.affiliation: Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-9238, USA.
authors.forename: Canan Asli
authors.initials: CA
authors.lastname: Utine
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tzu
authors.forename: Karen
authors.initials: K
authors.lastname: Dunlap
authors.forename: Esen Karamursel
authors.initials: EK
authors.lastname: Akpek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001187:Artificial Organs; D003315:Cornea; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D057972:Posterior Eye Segment / Q000601:surgery; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D019591:Pseudophakia / Q000503:physiopathology / Q000601:surgery*; D012030:Refractive Errors / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult