title: Visual outcomes and complications following posterior iris-claw aphakic intraocular lens implantation combined with penetrating keratoplasty.
abstract: BACKGROUND
  To evaluate the indication, visual outcome, and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL) during penetrating keratoplasty.
  
  
  METHODS
  This retrospective study comprised 23 eyes (23 patients) without adequate capsule support undergoing posterior iris-claw aphakic IOL implantation (Verisyse/Artisan) during penetrating keratoplasty between 2005 and 2010. Mean follow-up was 18 months (range from 12 to 37 months).
  
  
  RESULTS
  The IOLs were inserted during an IOL exchange in 17 eyes and as a secondary procedure in six aphakic eyes. Pseudophakic bullous keratopathy with corneal scar after anterior chamber intraocular lens (ACIOL) was the main indication for penetrating keratoplasty in 16 eyes (69.6 %). The final corrected distance visual acuity (CDVA) in logMAR (mean 1.0 ± 0.46) improved significantly (p < 0.05) compared to the preoperative CDVA (mean 1.8 ± 0.73). Twenty eyes (86.9 %) had a final visual acuity in logMAR better than the pre-operative CDVA. The mean postoperative IOP 16.3 mmHg ± 4.0 was not significantly (p > 0.05) higher compared to the preoperative IOP 15.6 mmHg ± 5.1. Complications included slight temporary pupil ovalization in three eyes (13.0 %) and iris-claw IOL sublocation in three eyes (13.0 %); all IOLs could be easily repositioned. Cystoid macular edema occured in one eye (4.3 %) 8 weeks after primary surgery. All grafts remained clear without any sign of graft rejection.
  
  
  CONCLUSIONS
  Retropupillar iris-claw IOL during penetrating keratoplasty provides good visual outcomes with a favorable complication rate, and can be used for a wide range of indications in eyes without adequate capsule support.
authors.affiliation: Department of Ophthalmology, Charité, University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany, johannes.gonnermann@charite.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Gonnermann
authors.forename: Necip
authors.initials: N
authors.lastname: Torun
authors.forename: Matthias K J
authors.initials: MK
authors.lastname: Klamann
authors.forename: Anna-Karina B
authors.initials: AK
authors.lastname: Maier
authors.forename: Christoph V
authors.initials: CV
authors.lastname: Sonnleithner
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Joussen
authors.forename: Peter W
authors.initials: PW
authors.lastname: Rieck
authors.forename: Eckart
authors.initials: E
authors.lastname: Bertelmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001036:Aphakia, Postcataract / Q000503:physiopathology / Q000601:surgery*; D002452:Cell Count; D003131:Combined Modality Therapy; D003316:Corneal Diseases / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007498:Iris / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*