Aphakic Corneal Edema Research Articles

Prediction of visual outcome after penetrating keratoplasty for pseudophakic corneal edema

Objective To evaluate the ability to predict visual outcome after penetrating keratoplasty (PKP) in patients with pseudophakic corneal edema (PCE) or aphakic corneal edema (ACE) based on preoperative parameters available from the patient history and ocular examination. Design Retrospective noncomparative case series. Participants Forty-eight patients who underwent 59 PKP procedures for PCE between 1997 and 2000 by two cornea specialists. Methods Medical records were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. Variables included age, gender, presence of diabetes or cardiovascular disease, method of intraocular lens (IOL) implantation during cataract surgery, vitreous loss during cataract surgery, time between cataract and PKP surgery, and maximal visual acuity reached after cataract surgery. The predictive value of each preoperative variable on post-PKP visual outcome was assessed using both univariate and multiple regression analyses. Main outcome measures Statistical significance for the predictive value of each preoperative variable on post-PKP visual outcome. Results Best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 13 patients (27%). The strongest predictor of this outcome was implantation of a bag-fixated or sulcus-fixated IOL at the time of cataract surgery ( P = 0.007; odds ratio, 15.8; 95% confidence interval, 1.2–208). Less significant variables included BCVA after cataract surgery, time between cataract surgery and PKP, and gender. Conclusions In planning and advising patients with pseudophakic or aphakic corneal edema who are candidates for PKP, the method of IOL implantation during the cataract surgery is the single most significant predictor of visual acuity after corneal transplantation. Bag-fixated or sulcus-fixated posterior chamber IOL was associated with a better visual outcome than anterior chamber IOL, scleral-fixated posterior chamber IOL, or aphakia.

Indications for corneal transplantation in New Zealand: 1991-1999.

To identify the indications for keratoplasty in patients supplied with donor tissue through the New Zealand National Eye Bank. Analysis of penetrating and lamellar keratoplasty data collected by the New Zealand National Eye Bank, Auckland, from 1991 to 1999. In this 9-year period, donor material was supplied for 1370 corneal grafts; 1308 for penetrating keratoplasty, 26 for lamellar keratoplasty, and 36 for unspecified grafts. This accounts for a minimum of 85% of the penetrating keratoplasties performed in New Zealand from 1991 to 1999. The leading indications for penetrating keratoplasty were keratoconus (45.6%), pseudophakic or aphakic corneal edema (17.9%), regraft (8.7%), viral keratitis (7.3%), and trauma (5.5%). The average age of patients was 47.5 years (SD = 22.6) and age distribution was bimodal, with peaks in the 3rd and 8th decades. Keratoconus, regraft, and trauma were significantly more common as indicators for penetrating keratoplasty in male patients than female patients; however, pseudophakic or aphakic corneal edema was more common in female patients. The majority of transplantation surgery in New Zealand is performed using corneal tissue from the New Zealand National Eye Bank. In this representative study, keratoconus is the leading indicator for penetrating keratoplasty in New Zealand, accounting for a higher proportion than in any other published literature. The other indications, age distribution and gender differences correlate with previous reports. These findings suggest that keratoconus leading to transplantation may have increased prevalence in New Zealand.

Retrieval of a Dropped Corneal Button From a Vitrectomized Eye

A successful retrieval of a dropped corneal button from an aphakic vitrectomized eye during penetrating keratoplasty is reported. A 52-year-old female patient underwent penetrating keratoplasty for aphakic corneal edema in a vitrectomized eye. The donor button inadvertently dropped into the vitreous cavity and was retrieved successfully. The dropped corneal button was visualized after focusing the operating microscope on the retina. The visualization significantly improved after aspiration of the fluid from the vitrectomized eye. The donor button was picked up by McPherson's forceps and subsequently sutured to the recipient's cornea. Corneal surgeons need to be aware of this rare complication in aphakic vitrectomized eyes and its retrieval after accurate visualization.

Implantation of Scleral-sutured Posterior Chamber Intraocular Lenses During Penetrating Keratoplasty

To evaluate the clinical outcome in 29 patients (29 eyes) who underwent penetrating keratoplasty and scleral-fixation of an intraocular lens. The indications for penetrating keratoplasty with scleral-fixation of an intraocular lens were anterior chamber pseudophakic corneal edema, aphakic corneal edema, trauma, and corneal scars. Patients with pseudophakic corneal edema underwent IOL exchange and penetrating keratoplasty and patients with lens subluxation underwent cataract extraction and penetrating keratoplasty in the same operation session. Preoperative spectacle-corrected visual acuity was hand motion in 13 eyes (44.8%) and 20/400 in 18 eyes (61.5%). Postoperative spectacle-corrected visual acuity of 20/400 or better was observed in 25 eyes (86.2%). At last follow-up, 26 corneal grafts (89.7%) remained clear. Three grafts (10.3%) failed, two because of glaucoma and one because of endophthalmitis. Glaucoma was observed in 7 eyes. Trans-scleral fixation of intraocular lenses combined with penetrating keratoplasty was a useful surgical technique in eyes with keratopathy and lacking posterior capsular support.

Changing Indications for Penetrating Keratoplasty, 1989???1993

The purpose of this study was to identify new trends in the changing indications for penetrating keratoplasty. We retrospectively reviewed the clinical and pathologic diagnoses of 1,104 corneal buttons that had been submitted to the Estelle Doheny Eye Pathology Laboratory, Los Angeles, during the 5-year period 1989-1993. The leading indications, in order of decreasing frequency, were pseudophakic corneal edema (24.8%), regrafts (21.3%), scarring with or without chronic inflammation (11.1%), keratoconus (7.1%), aphakic corneal edema (6.4%), and ulcerative conditions (5.8%). The incidence of pseudophakic corneal edema remained stable over the study period and was actually surpassed by regraft in the last year of the study. Although pseudophakic corneal edema remains the predominant indication for penetrating keratoplasty, our findings suggest that its occurrence rate has begun to level off.

Iris Claw Lens: Anterior and Posterior Iris Surface Fixation in the Absence of Capsular Support During Penetrating Keratoplasty

Intraocular lens implantation in eyes with pseudophakic or aphakic corneal edema and insufficient posterior capsular support presents a surgical challenge. The iris claw lens has the advantage that it can be fixated to the iris without sutures because the peripheral iris is incarcerated between the claws. We present the results of a study with implantation of an iris claw lens in combination with penetrating keratoplasty in 19 eyes of 19 patients with pseudophakic or aphakic corneal edema which lacked posterior capsular support. The lens was fixated on the anterior iris surface (12 eyes) or posterior iris surface (seven eyes). Mean follow-up time was 11.8 months (7 to 21 months). All grafts remained clear. One patient was lost for follow up after 3 months. Visual acuity improved in 83% of the patients. Twenty-eight percent of the patients had a visual acuity of > or = 20/40. Complications such as pigment dispersion, glaucoma, peripheral synechiae, and lens decentration were rare. We feel iris claw lens implantation combined with penetrating keratoplasty is a safe alternative to achieve pseudophakia in eyes with corneal edema and inadequate posterior capsular support.

Indications and techniques of penetrating keratoplasties, 1985-1988.

Indications and surgical techniques for penetrating keratoplasties (PKs) were evaluated to determine present trends and suggest future directions for PK. Analyses were based on 3,941 PK cases, with questionnaires completed at the time of surgery by 638 surgeons receiving tissue through Tissue Banks International, Inc. between July 1, 1985, and December 31, 1988. The leading indications for PK were pseudophakic corneal edema (PCE) (23%), graft failure (17%), Fuchs' corneal dystrophy (13%), kerataconus (13%), keratitis/scar (12%), and aphakic corneal edema (10%). Indications for PK varied by age and sex. Anterior chamber (AC) lenses accounted for the majority (56%) of PCE cases. Penetrating keratoplasty for PCE occurred within 5 years of cataract surgery for 81% of patients with PC lenses and only 52% of patients with AC lenses. Intraocular lens exchange was performed in most AC and iris-fixed lens PCE cases (65% and 77%, respectively), but less frequently in PC lens cases (17%). A PC lens was placed in 29% of all PCE lens exchange cases. These data have confirmed and expanded observations from smaller studies about leading indications and surgical techniques for PK. Therefore, eye bank data may be useful in describing and monitoring future indications and trends for PK because they provide a broader base of information than that obtained through a single institution.

Posterior Chamber IOL Implantation During Keratoplasty for Aphakic or Pseudophakic Corneal Edema

Because of their many advantages, posterior chamber (PC) intraocular lenses (IOLs) were sutured to the posterior iris (in the absence of a lens capsule) in combination with penetrating keratoplasty for aphakic and pseudophakic corneal edema in 53 cases. Secondary PC IOL implantations were performed in aphakic corneal edema (nine cases), and IOLs were exchanged for PC IOLs in pseudophakic corneal edema (44 cases). Ninety-six percent of the grafts remained clear. Forty-three percent of the eyes had 20/40 or better visual acuity, 38% between 20/50 and 20/200, and 19% worse than 20/200, with an average follow-up time of 6.4 (range 3-13) months. The most common cause of poor vision was cystoid macular edema present preoperatively in 20 eyes and postoperatively in 22 eyes. Other causes of persistent visual impairment included macular degeneration (five cases), retinal detachment (two cases), preoperative glaucoma damage (one case), severe postoperative glaucoma damage (one case), endophthalmitis (one case), and graft rejection (one case). Our short-term results indicate that this procedure may be a viable alternative to the use of secondary anterior chamber IOL implantation during penetrating keratoplasty.

Results of Penetrating Keratoplasty in 123 Eyes with Pseudophakic or Aphakic Corneal Edema

The clinical records of 123 eyes that received a penetrating keratoplasty for aphakic or pseudophakic corneal edema with a mean follow-up time of 18 months were studied retrospectively. Thirty-five eyes from which an intraocular lens (IOL—85% iris fixated) was removed at the time of keratoplasty were compared with 88 eyes that never had an IOL. The mean interval between initial cataract surgery and penetrating keratoplasty was 28 months for the pseudophakic group from which the IOL was removed and 67 months for the aphakic group without IOL. In both groups, 97% had an anterior vitrectomy. Corneal grafts remained clear in 91% of the previously pseudophakic eyes and in 81% of the aphakic eyes (P ≤ 0.05). The final corrected visual acuity was worse in the pseudophakic eyes with IOL removed (16% saw 6/6 to 6/12 while 22% saw worse than 6/60) than in the aphakic eyes (34% saw 6/6 to 6/12 while 7% saw worse than 6/60). Postoperative maculopathy occurred in 43% of eyes from which IOLs were removed and in 22% of aphakic eyes.