Endothelial keratoplasty with anterior chamber intraocular lens versus secondary posterior chamber intraocular lens

Abstract

AimTo describe the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with an anterior chamber intraocular lens (ACIOL) compared to secondary posterior chamber (PC) IOL.MethodsThis was a retrospective comparative cohort study. The clinical data of 82 eyes from 82 consecutive patients with pseudophakic (PBK) or aphakic bullous keratopathy (ABK) who either underwent DSAEK with retained or secondary ACIOL (n=23) or DSAEK with IOL exchange and/or secondary PCIOL (retropupillary iris-claw IOL, n=25; intrascleral-fixated IOL, n=29; or sulcus IOL, n=5) were analysed. The main outcome measures were graft survival and complications up to 5 years.ResultsThe graft survival in the secondary PCIOL group was superior than the ACIOL group over 5 years (year 1, 100.0% vs 100.0%; year 3, 94.7% vs 75.0%; year 5, 91.1% vs 60.6%, p=0.022). The presence of an ACIOL was a significant risk factor associated with graft failure (HR, 4.801; 95% CI, 1.406 to 16.396, p=0.012) compared to a secondary PCIOL. There was no significant difference in the rate of graft detachment and elevated intraocular pressure between the groups. There were five cases (9.3%) of IOL subluxation or dislocation in the retropupillary iris-claw and intrascleral-fixated IOL groups.ConclusionsEyes that underwent DSAEK with ACIOL in situ had poorer long-term graft survival compared with those with secondary PCIOL. Intraocular lens exchange was not associated with a higher complication rate. In ABK or PBK eyes with ACIOL, we recommend performing IOL exchange and/or secondary PCIOL implantation combined with endothelial keratoplasty.

Implantation of retropupillary iris‐claw lenses: A review on surgical management and outcomes

“…2019; Woo et al. 2020), whereas the rest were case series. The comparative studies (two prospective and seven retrospective) focused on retropupillary iris‐claw lenses versus repositioning of the dislocated IOL–capsule complex with sutures to the sclera (Kristianslund et al.…”

Outcomes of Secondary Intraocular Lens Implantation and Descemet Stripping Endothelial Keratoplasty—Comparing Staged Versus Combined Surgical Approach

“…Previous retrospective cohort studies have compared the outcomes of endothelial keratoplasty (EK) with a retained ACIOL versus a PCIOL 5,6 or EK with staged or combined IOL exchange versus EK alone in pseudophakic eyes. 4,[7][8][9][10][11] Some authors have previously described the outcomes of combined DSEK with IOL techniques. 2,[12][13][14][15][16][17][18] Frequently, the decision to perform a staged versus combined approach is left to the clinician's discretion.…”

Descemet membrane endothelial keratoplasty in a patient with iris-fixated intraocular lens and prior radial keratotomy: a case report

“…Further challenges may be present with potentially unstable IOLs such as IF-IOLs [ 12 ]. The goal of iris fixation was to decrease negative dysphotopsias by reducing the posterior chamber depth [ 13 ].…”