A RANDOMIZED TRIAL OF INTRAOCULAR-LENS FIXATION TECHNIQUES WITH PENETRATING KERATOPLASTY

Purpose: Pseudophakic corneal edema is the principal indication for pe netrating keratoplasty in the United States. Currently, three techniqu es of intraocular lens (IOL) fixation during penetrating keratoplasty for this condition are commonly used-flexible anterior chamber IOL (AC IOL) implantation, iris suture fixation of a posterior chamber IOL (P C IOL), and transscleral suture fixation of a PC IOL. This study repre sents the first prospective, randomized comparison of these three tech niques. Methods. One hundred seventy-six consecutive patients with pse udophakic corneal edema who underwent penetrating keratoplasty with IO L exchange were randomized to one of the three implantation techniques . Standardized evaluations were performed at baseline and at 6, 12, an d 18 months postoperatively. Life-table analysis provided cumulative r isk estimates for specific complications. Results. Randomization produ ced comparable groups at baseline. The cumulative risk of macular edem a was significantly less for the iris fixation cohort than for either the AC IOL or scleral fixation group. A complications index was constr ucted based on the major adverse outcomes of glaucoma escalation, cyst oid macular edema, IOL dislocation, and graft failure. A significantly lower risk of complication was found for iris compared with scleral f ixation of PC IOLs. Conclusion: The authors conclude that transscleral fixation of the PC IOL at the time of penetrating keratoplasty for ps eudophakic corneal edema is associated with a greater risk of adverse outcome than iris fixation of a PC IOL.