RESULTS OF IMPLANTATION OF TRANSSCLERALLY SUTURED POSTERIOR CHAMBER LENSES IN COMBINATION WITH PENETRATING KERATOPLASTY

Implantation of transsclerally sutured posterior chamber lenses is one possibility of surgical visual rehabilitation of eyes with pseudophac ic or aphacic bullous keratopathy without zonular-capsular support. We analyzed the results and complications of the surgical procedures per formed in our institution. Patients and methods: Out of 1567 penetrati ng keratoplasties and 220 transsclerally sutured posterior chamber len ses that were performed at our institution between 1991 and 1996, pati ents that underwent penetrating keratoplasty and sutured posterior cha mber lens implantation in whom sufficient clinical information was ava ilable were selected and analyzed in a retrospective, nonselective stu dy. Surgery was performed by a total of four surgeons and included ant erior vitrectomy, inside-out suturing and synechiolysis if necessary. Detailed pre- and intraoperative data, postoperative course and compli cations were recorded and analyzed. Results: A total of 96 eyes were a nalyzed (patient age 17-92 years, 49 male, 46 female). Penetrating ker atoplasty was performed for pseudophacic (63) oder aphacic (15) bullou s keratopathy or for corneal scars following penetrating injury (18). Mean follow-up was 22 months. In 82 of 96 eyes, visual acuity improved following surgery. Complications included rhegmatogenous retinal deta chment in 4 eyes, graft rejection in 5 eyes, secondary angle-closure g laucoma caused by preexisting anterior synechiae in 7 eyes, and persis ting cystoid macular edema in 19 eyes. Luxation or subluxation of the IOL and endophthalmitis were not observed in any of the patients. Conc lusion: Implantation of transsclerally sutured posterior chamber lense s appears to be a safe procedure and is considered by us to be the pro cedure of choice to correct aphacia during penetrating keratoplasty in eyes with absent zonular-capsular support. The majority of postoperat ive complications is apparently caused by preexisting problems related to previous surgery and/or trauma, such as peripheral anterior synech iae, vitreous incarceration or cystoid macular edema.