Supplementary, Sulcus-Fixated Intraocular Lens in the Treatment of Spherical and Astigmatic Refractive Errors in Pseudophakic Eyes After Keratoplasty.

Abstract

To evaluate the efficacy, refractive outcomes, and complications of supplementary intraocular lens (IOL) implantation in pseudophakic eyes after keratoplasty. This is a retrospective review of pseudophakic postkeratoplasty eyes after implantation of a custom-designed, sulcus-fixated, supplementary "piggyback" IOL to correct refractive errors. The outcome measures included preoperative and postoperative uncorrected distance visual acuity (UDVA), spectacle-corrected distance visual acuity (CDVA), refractive correction, and complications. This study evaluated 10 eyes (10 patients) with previous penetrating or deep anterior lamellar keratoplasty with a mean follow-up period of 12.2 ± 10.7 months (range, 2-33 months). All eyes showed improved UDVA postoperatively with 70% achieving ≥20/40. Median UDVA (logarithm of the minimum angle of resolution) improved from 1.2 (20/280, range 20/70-20/2000) preoperatively to 0.3 (20/40, range 20/20-20/60) postoperatively at the latest follow-up visit (P < 0.01). Five eyes (50%) had improvement in CDVA by at least 1 line of Snellen acuity with all eyes achieving ≥20/40 and 70% achieving ≥20/25. Median CDVA (logarithm of the minimum angle of resolution) was 0.2 (20/30, range 20/20-20/50) preoperatively compared with 0.1 (20/25, range 20/20-20/40) postoperatively (P = 0.03). In 8 eyes that received toric secondary IOLs, the mean refractive astigmatism decreased by 84% from 5.7 diopters (D) (range, 4-9 D) to 0.9 D (range, 0.2-3.0 D) (P = 0.01). Postoperative refractive astigmatism was ±1 D of predicted astigmatism for 7 of 8 eyes. No eyes lost any lines of UDVA or CDVA, and there were no keratoplasty rejection/failure events. Implantation of a supplementary, sulcus-based IOL is an effective approach to reduce spherical and astigmatic refractive errors in pseudophakic eyes after keratoplasty.