Abstract
A retrospective analysis of 198 eyes with pseudophakic bullous keratopathy undergoing penetrating keratoplasty with or without intraocular (IOL) exchange was performed over an 11-year period. The 198 eyes evaluated consisted of 86 anterior chamber (AC), 27 iris fixated (IF), and 85 posterior chamber (PC) lenses. Patients were followed up for an average of 3.2 ± 1.3 years. The mean intervals between initial cataract surgery and penetrating keratoplasty were 38 ± 4, 44 ± 3, and 3 ± 1.2 months with AC, IF and PC lenses, respectively. Pre-existing endothelial changes in fellow eyes were present in 56% of cases. Anterior vitrectomy was performed in 93% of AC, 54% of IF, and 35% of PC lenses. More than half of the PC lenses (58.8%) were retained as opposed to 1.7% of AC lenses and 0% of IF lenses. Maximum grafts remained clear with posterior chamber implants (83%) at the time of mean follow up. Visual acuity of 6/18 or more was achieved in 15% of eyes with AC, 17% with IF, and 45% PC with implants respectively. The most common cause of graft failure was raised intraocular pressure with all types of pseudo- phakos. The leading causes of non-improvement of vision in the presence of clear graft were cystoid macular edema (40%) and glaucomatous optic atrophy (37.1%).
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