Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty.
OBJECTIVE
To evaluate clinical outcomes and complications after Descemet membrane endothelial keratoplasty (DMEK) and posterior iris-claw aphakic intraocular lens (IOL) implantation.


METHODS
This prospective cohort study comprised seven consecutive eyes (seven patients) without adequate capsular support and bullous keratopathy undergoing posterior iris-claw aphakic IOL implantation and DMEK. Corneal transparency, central corneal thickness, endothelial cell density, visual outcomes and complication rates were measured during the follow-up.


RESULTS
The iris-claw IOLs were inserted during an IOL exchange in three eyes, and as a secondary IOL implantation in one aphakic eye during DMEK procedure. Three eyes had IOL exchange prior to secondary DMEK. Mean follow-up was 7 months (range 3-14 months). The final best spectacle-corrected visual acuity improved significantly (0.33±0.31 logMAR) compared with the preoperative best spectacle-corrected visual acuity (1.84±0.90 logMAR). The mean endothelial cell loss was 24.8% over the follow-up. Complications included graft dislocation in four eyes; which could be easily reattached with a rebubbling procedure. No graft failures, no cases of pupillary block glaucoma and no IOL dislocations were encountered.


CONCLUSIONS
DMEK and retropupillar iris-claw IOL implantation provide good visual outcomes with a fast visual recovery and appear to be a feasible method for the management of bullous keratopathy but with higher graft detachment rates.


BACKGROUND
NCT02020044.
Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Johannes
J
Gonnermann
Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Anna-Karina B
AK
Maier
Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Matthias K J
MK
Klamann
Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Tobias
http://orcid.org/0000-0001-6939-1159
T
Brockmann
Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Eckart
E
Bertelmann
Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Antonia M
AM
Joussen
Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Necip
N
Torun
D000368:Aged; D000369:Aged, 80 and over; D001036:Aphakia, Postcataract / Q000503:physiopathology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007910:Lenses, Intraocular; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D020858:Tissue and Organ Harvesting / Q000379:methods; D014792:Visual Acuity
Anterior chamber; Cornea