Penetrating keratoplasty in iridocorneal endothelial syndrome

Purpose. To evaluate the clinical outcome of penetrating keratoplasty (PK) in iridocorneal endothelial (ICE) syndrome. Methods, Clinical charts of patients who underwent penetrating keratoplasty for ICE syndrome between 1985 and 1999 were reviewed retrospectively. Glau coma control, best corrected visual acuity pre- and post-PK, graft clarity, graft rejection episodes, improvement in pain, and additional procedures w ere analyzed. Results. Fourteen cases were reviewed with an average follow-up of 58 month s after PK. Initial grafts failed in seven patients (50%), in six cases bec ause of rejection, and one owing to endothelial failure without signs of re jection. Repeat PKs were performed in six patients. At final follow-up, 12 grafts were clear. Glaucoma was controlled pre- and post-PK (average intrao cular pressure, 16 mmHg for both eyes). Pre-PK, eight patients were using g laucoma medicines and nine had had glaucoma surgery. At the end of the foll ow-up, seven patients were using glaucoma medicines, six patients required glaucoma surgery after their initial PK. At the final follow-up visit, visu al acuity in three patients (21%) was 20/40 or better, it ranged from 20/50 to 20/100 in four patients (29%) and 20/200 to 20/400 in five patients (36 %), and in two patients with failed grafts (14%) it was counting fingers or worse. Conclusion, Clear grafts were achieved in 12 cases, although six patients ( 43%) underwent repeat PKs. All patients had glaucoma, which was controlled before and after PK by medical treatment and surgical procedures. Favorable outcomes can be achieved in patients with ICE syndrome but may require mul tiple corneal and glaucoma procedures.