PENETRATING KERATOPLASTY AND INTRAOCULAR-LENS EXCHANGE - OPEN-LOOP ANTERIOR-CHAMBER LENSES VERSUS SUTURED POSTERIOR CHAMBER LENSES

Penetrating keratoplasty with intraocular lens (IOL) exchange is gener ally recommended for eyes with pseudophakic bullous keratopathy, espec ially when the keratopathy is associated with uveitis, chronic cystoid macular edema, or a uveitis-glaucoma-hyphema syndrome. Review of the literature has shown basically equivalent long-term results of penetra ting keratoplasty and IOL exchange using both Kelman-style, flexible, open-loop anterior chamber lenses and acapsular fixation of sutured po sterior chamber lenses. The use of suture-fixated posterior chamber IO Ls appears warranted in centers where the surgeon has extensive experi ence with this specific technique and in cases with special indication s, for example, in eyes with extensive angle abnormalities. However, b ecause this technique is more difficult to perform, and in the absence of such preexisting contraindications, for most practices we do not h esitate to recommend the use of a Kelman-style anterior chamber lens d uring routine cases of penetrating keratoplasty and IOL exchange.