CLINICAL AND ANATOMICAL STUDY OF THE EFFECT OF TRANSSCLERAL FIXATION OF POSTERIOR CHAMBER LENSES ON EARLY POSTKERATOPLASTY ASTIGMATISM

We reviewed the pattern of astigmatism after penetrating keratoplasty and transsclerally sutured posterior chamber lens (TSPCL) placement in 73 patients. Thirty-five patients (48%) had an axis of astigmatism or iented perpendicularly to the haptics of the TSPCL. Twenty-seven patie nts (37%) had an orientation of astigmatism that was in the same merid ian as the haptics of the TSPCL. Eleven patients (15%) had an axis of astigmatism oriented obliquely to the meridian of the haptics of the T SPCL. The distance the haptic fixation sutures were placed behind the limbus appeared to be correlated with the orientation of astigmatism. Patients having the lens fixated within 0.75 mm of the limbus were mor e likely to have astigmatism oriented perpendicular to the meridian of the haptics of the posterior chamber lens in the early postoperative period. Patients having the lens fixated 2-3 mm posterior to the limbu s were more likely to have astigmatism oriented in the same meridian a s the haptics of the posterior chamber lens in the early postoperative period. In an eye bank model of TSPCLs during penetrating keratoplast y, the placement of a posterior chamber lens with haptics fixated with in 0.75 mm of the limbus significantly widens the recipient bed an ave rage of 0.3 mm in the meridian of the haptics of lens placement (p = 0 .02). When the posterior chamber lens haptics were fixated 3 mm poster ior to the limbus, the recipient bed was significantly narrowed in the meridian of lens placement an average of 0.2 mm (p = 0.02). It appear s that the TSPCLs may have an effect on early postkeratoplasty astigma tism by distorting the corneal wound at the time of keratoplasty.