Aphakic Group Research Articles

Influence of Postoperative Lens Status on Intraocular Pressure in Proliferative Vitreoretinopathy

To determine the influence of lens status on postoperative intraocular pressure (IOP) in eyes undergoing vitrectomy for repair of recurrent retinal detachment (RD) resulting from proliferative vitreoretinopathy (PVR). Retrospective, consecutive, nonrandomized, single-center series. One hundred and forty-five eyes with recurrent RD resulting from PVR were reviewed retrospectively. In all, 99 eyes underwent relaxing retinotomy at the time of surgery (68.4%). Perfluorocarbon gas (n = 60) or silicone oil (n = 85) were used as postoperative tamponades. For analysis, eyes were subdivided first based on tamponade and retinotomy status. The resultant groups then were divided further by lens status into 2 groups: aphakic eyes (aphakic group) and phakic and pseudophakic eyes (nonaphakic group). Surgical reattachment was achieved in all eyes except one. Eyes receiving both silicone oil and relaxing retinotomy had the worst baseline characteristics compared with those receiving other interventions. In this subset of eyes, a significantly lower proportion of hypotony was found in those eyes that were aphakic after surgery when compared with those eyes that were nonaphakic (P = .037). Surgical management of PVR often results in ultimate retinal reattachment. In eyes receiving both relaxing retinotomy and silicone oil, higher IOPs and a lower proportion of hypotony are found where a native lens or intraocular implant is absent. Removal of the lens or intraocular implant may be considered for those eyes at greatest risk of hypotony.

Aqueous drainage device surgery in refractory pediatric glaucomas: I. Long-term outcomes

To determine the long-term outcomes and complications of aqueous drainage device surgery in children with congenital and aphakic glaucoma. Chart review of consecutive children treated with aqueous drainage device surgery at Duke University Eye Center from 1995 to 2006, recording demographic, glaucoma-related, and anterior segment examination findings. Included are 30 children (38 eyes) with congenital glaucoma and 32 children (41 eyes) with aphakic glaucoma. Median follow-up was 5.5 years (0.5-10.5) in the congenital glaucoma group and 3.5 years (0.5-13.8) in the aphakic glaucoma group. Pre-aqueous drainage device median intraocular pressure (IOP) was 29 mmHg in the congenital glaucoma group and 36 mmHg in the aphakic glaucoma group. Post-aqueous drainage device median IOP was 14 and 15 mmHg in the congenital and aphakic glaucoma group, respectively (p < 0.0001 vs pre-aqueous drainage device IOP). Post-aqueous drainage device pupil abnormalities were noted in 16% and 7% of eyes in the congenital glaucoma and aphakic glaucoma groups, respectively, and cataract occurred in 20% of phakic eyes in the congenital glaucoma group. Reoperation was necessary in 26% and 22% of eyes in the congenital glaucoma and aphakic glaucoma groups, respectively. One-year Kaplan-Meier success was 92% and 90% in the congenital and aphakic glaucoma groups, respectively, but fell by 10 years to 42% and 55%, respectively. Vision-threatening complications occurred in 10% of eyes overall. Aqueous drainage device surgery is moderately successful in children with refractory congenital and aphakic glaucoma. Common complications include corneal touch and cataract; iris abnormalities occur less commonly.

Aqueous drainage device surgery in refractory pediatric glaucoma: II. Ocular motility consequences

To determine the prevalence of complications relating to ocular motility and alignment in children with refractory congenital and aphakic glaucoma treated with aqueous drainage device surgery. Chart review of consecutive children treated with aqueous drainage devices at Duke University Eye Center from 1995 to 2006 for ocular motility abnormalities and strabismus as well as sensorimotor testing results before and after aqueous drainage device placement. Thirty-eight eyes of 30 children with congenital glaucoma and 41 eyes of 32 children with aphakic glaucoma were included. Optotype visual acuity testing could be performed in a minority of children preoperatively. After aqueous drainage device surgery, 14 and 20 eyes, respectively, were >20/100 in the congenital glaucoma and aphakic glaucoma groups. Only a few children had stereopsis or demonstrated binocular function on Worth 4-Dot testing in both groups before and after aqueous drainage device surgery. Horizontal and vertical strabismus was common, especially after aqueous drainage device surgery and occurred in 57% of congenital glaucoma patients and 47% of aphakic glaucoma patients. Motility limitation (both vertical and horizontal) was also common and occurred in 37% overall. Ocular motility abnormalities and strabismus were common in children after aqueous drainage device surgery. These potential problems should be considered when aqueous drainage device surgery is planned, especially in children with binocularity.

The effect of elective phacofragmentation on central corneal thickness in the dog

To characterize the short- and intermediate-term effects of elective phacofragmentation on central corneal thickness (CCT) in the dog. Forty-three dogs (66 eyes) undergoing elective phacofragmentation cataract surgery over an 8-month period at a single private ophthalmology referral clinic were enrolled in the study. Central corneal thickness was measured by ultrasonic pachymetry just prior to surgery, 1 day following surgery, 1 week postoperatively, 1 month postoperatively, and more than 2 months postoperatively. Statistical comparisons were made using descriptive and inferential statistical methods with a level of significance set at P < 0.05. The initial mean CCT of 611 microm increased dramatically to 741 microm 1 day postphacofragmentation. Mean CCT remained slightly elevated (666 microm) at 1 week postoperatively, but became indistinguishable from preoperative measurements by 1 month postsurgery (626 microm) and remained so at the > 2-month time period (618 microm). The change over time and trends remained statistically significant and remarkably similar, even when adjusted separately for age, gender, surgeon status, diabetic status, cataract type, and total surgery time (all P < 0.0001). Corneas of diabetic dogs were thicker than those of nondiabetic dogs at all time periods, and the overall effect of diabetic status was significant (P = 0.016). There was a sharper increase from the preoperative to 1-day postoperative CCT in the diabetic group compared to the nondiabetic group. The mean CCT of the pseudophakic group took longer to return to baseline than the aphakic group. The mean CCT of the foldable intraocular lens (IOL) group took longer to return to baseline than both the rigid IOL and aphakic groups. Dogs with documented in-hospital postoperative intraocular pressure spikes (> 25 mmHg) developed a greater 1-day postsurgical increase in CCT. It appears that there was a sharper decrease in mean CCT from 1 month to more than 2 months postoperatively in the postoperative hypertension group. Elective phacofragmentation cataract surgery results in an increase in CCT in dogs, but this increase is transient. Particular care may be indicated to protect the endothelium of diabetic patients undergoing phacofragmentation. These data do not clearly support an advantage of the small-incision cataract surgery made possible by the use of foldable IOLs.

Intraocular Lens Implantation after Atopic Cataract Surgery Decreases Incidence of Postoperative Retinal Detachment

To investigate the efficacy of intraocular lens (IOL) implantation in reducing the incidence of postoperative retinal detachment after cataract surgery in patients with atopic dermatitis. Retrospective review. One hundred sixty-nine eyes of 126 patients who underwent cataract surgery for atopic cataract were followed for more than 1 year. None of the eyes previously had a retinal detachment or retinal detachment surgery. The eyes were divided into 132 eyes of 95 patients with an IOL implantation (IOL group) and 37 eyes of 31 patients without an IOL implantation (aphakia group). The postoperative visual acuity and incidence of postoperative retinal detachment were compared between the 2 groups. The effects of the location of the causative retinal breaks, intraoperative posterior capsule rupture, and postoperative posterior capsulotomy on the incidence of retinal detachments were evaluated. The postoperative corrected visual acuity, incidence of postoperative retinal detachment, and influence of intraoperative posterior capsule rupture on the retinal detachment. The final visual acuity was better than or equal to 20/20 in 128 eyes (97.0%) of the IOL group and in 29 eyes (78.4%) of the aphakia group (P = 0.0007). Retinal detachment after an uncomplicated cataract surgery occurred in 3 eyes (2.3%) of the IOL group and in 8 eyes (25.8%) of the aphakia group (P<0.0001, Mantel-Cox). Two of 3 eyes (66.7%) in the IOL group and 1 of 8 eyes (16.7%) in the aphakia group that later developed a retinal detachment had an intraoperative posterior capsule rupture. Posterior capsulotomy by yttrium-aluminum-garnet laser did not seem to alter the incidence of postoperative retinal detachment in either the IOL (2.0%) or the aphakia group (25.0%). The rate of postoperative retinal detachment in eyes with IOL and no intraoperative posterior capsule rupture seems to be low. Intraocular lens implantation with capsular bag fixation may reduce the incidence of postoperative retinal detachment triggered by lens surgery for atopic cataract.

Cataract Extraction and Primary Hydrophobic Acrylic Intraocular Lens Implantation in Infants

We sought to report the incidence of visual axis opacification and to evaluate the complication and reoperation rates after intraocular lens implantation in infants. Twenty-one infants (31 eyes) who had cataract extraction with primary hydrophobic acrylic IOL implantation between October 1996 and May 2002 were reviewed. Posterior capsule was left intact in 14 eyes (group A); posterior capsulorrhexis or capsulotomy with anterior vitrectomy was performed in 17 eyes (group B). Complication and reoperation rates were compared with an age-matched control group of 17 patients (33 eyes) who were left aphakic after pars plicata lensectomy. Mean follow-up period was 41 months (range, 22-75 months) in group A, 37 months (range, 10-75 months) in group B, and 52 months (range, 7-97 months) in the control group. Mean age of the patients was 6.8 months (range, 3-10 months) in group A, 8.9 months (range, 3-18 months) in group B, and 4.9 months (range, 1-15 months) in the control group. Visual axis opacification was significantly higher in group A (86%) when compared with group B (17.6%; P < 0.0001). No significant difference was found in terms of pupillary irregularities and peripheral anterior synechiae formation between pseudophakic and aphakic group ( P = 0.43 and P = 0.306, respectively), whereas pigment dispersion and fibrinous reaction were significantly more common in the pseudophakic group ( P = 0.002). Serious complications, such as retinal detachment, pseudophakic bullous keratopathy, and secondary glaucoma, did not develop in any eye. Reoperation rate was significantly higher in group A (78%) when compared with group B (17%) and the control group (12%; P = 0.0011 and P < 0.0001, respectively). Visual axis opacification requiring a reoperation was significantly more common in patients with an intact posterior capsule. To decrease the reoperation rate and maintain a clear visual axis, posterior capsulorrhexis with anterior vitrectomy should be performed. Even although early complications were quite frequent, serious late complications were not encountered in any eye. Therefore, under appropriate conditions, IOL implantation is a suitable alternative in infants.

Filtration procedures supplemented with mitomycin C in the management of childhood glaucoma

AIMS To evaluate the outcome of filtering procedures supplemented with mitomycin C in children with glaucoma. METHODS All patients aged 17 or younger with glaucoma who underwent filtering surgery supplemented...

Outcomes and ocular growth rates after intraocular lens implantation in the first 2 years of life

Purpose: To evaluate the outcomes and ocular growth after intraocular lens (IOL) implantation in the first 2 years of life,Setting: University-affiliated eye institute.Methods: The medical records of consecutive children under 24 months of age who had cataract extraction with IOL implantation were reviewed. Change in axial length over time, postoperative complications, need for additional surgery, predicted versus actual postoperative refraction, and visual outcomes were recorded. Complication rates were compared with those in a similar group of age-matched patients who were left aphakic at the time of surgery.Results: Twenty-two eyes of 17 patients aged 12 days to 22 months had IOL implantation. Length of follow-up ranged from 2 to 36 months (mean 14 months). Visual acuity measurement, limited to fixation-preference testing in most patients, revealed amblyopia in the operated eye in the majority of cases. Postoperative refractive error, predicted using the Holladay formula, showed a mean error in prediction of 1.5 diopters (D) (range –1.8 to 4.1 D). Serial axial lengths in 11 patients with a mean follow-up of 20 months showed no significant difference in growth in the fellow versus the operated eye. There was no significant difference in complication rates between pseudophakic patients and the age-matched aphakic group. However, in 14 of 32 aphakic eyes (44%), a notation in the chart indicated that the patient had stopped wearing glasses or contact lenses for at least 2 months.Conclusion: Intraocular lens implantation appeared to be a safe and effective alternative to contact lens or spectacle, correction of aphakia in children younger than 2 years of age. It may aid amblyopia treatment by eliminating periods of uncorrected aphakia.

Photorefractive keratectomy for hyperopia and aphakia with a scanning spot excimer laser.

To study the safety, efficacy, predictability, and stability of photorefractive keratectomy (PRK) for hyperopia and aphakia. Fifteen eyes of 15 patients (mean age, 33 +/- 5.95 yrs) were enrolled in the study and divided into three groups. The first group was comprised of six eyes that had hyperopia ranging from +1.75 to +4.75 D; the second group had seven hyperopic eyes ranging from +5.00 to +9.75 D; the third group included two eyes of two aphakic patients. All eyes had PRK with a 193 nm argon fluoride excimer laser (Chiron-Technolas, Keracor 116) with a 10 Hz repetition rate and a fluence of 120 mJ/cm2. The total follow-up time in all eyes was 12 months. In the lower hyperopia group, 0% eyes were within +/- 0.50 D and 66% (N = 4) of eyes were within +/- 1.00 D of emmetropia with the other two eyes between +1.00 and +2.00 D at 1 year after PRK. In the higher hyperopia group, all eyes had at least +3.00 D of hyperopia at 1 year. In the aphakic group, both eyes achieved less than 50% of the target correction of +10.00 D at 1 year. Final uncorrected visual acuity ranged from 20/20 to 20/30 in the lower hyperopia group, 20/30 to 20/50 in the higher hyperopia group, and count fingers in the aphakic group. PRK is a relatively safe, stable, and effective procedure with reasonably good predictability for eyes with less than +5.00 D of baseline hyperopia, and poor predictability for eyes with more than +5.00 D of baseline hyperopia. PRK is ineffective in the correction of aphakia.

VANCOMYCIN LEVELS AFTER INTRAVITREAL INJECTION

Vancomycin hydrochloride for intraocular injection is the drug of choice for the treatment of suspected gram-positive endophthalmitis. To study its intraocular pharmacokinetics, we injected vancomycin into the vitreous cavity of phakic, aphakic, and aphakic-vitrectomized rabbit eyes and determined its rate of clearance. Inflamed eyes were compared to control eyes in each group. Three groups of eyes were prepared. The eyes in Group 1 were phakic, the eyes in Group 2 had the lens removed, and the eyes in Group 3 had both the lens and central vitreous removed. Each group was subdivided into a control group and a group made inflamed by injection of heat-killed Staphylococcus epidermidis. Vancomycin hydrochloride 1 mg in 0.1 cc of diluent was injected into the midvitreous cavity and samples obtained at 2 or 3, 8, 24, and 48 hours after injection. Vancomycin concentrations were measured and clearance rates were calculated for each of the groups. Vancomycin was cleared substantially faster from aphakic-vitrectomized eyes (half-life 9.0 hours) and aphakic eyes (half-life 8.9 hours) than phakic eyes (half-life 25.1 hours). Inflammation increased the rate of elimination of vancomycin only in the aphakic group. Clearance of vancomycin from the phakic eye is prolonged compared to that of beta-lactam antibiotics, an important pharmacokinetic advantage in treating endophthalmitis. Its clearance from aphakic-vitrectomized eyes is dramatically faster than from phakic eyes and is similar to that of other antimicrobial agents.

Surgical results and complications of goniosynechialysis.

Goniosynechialysis (GSL) was performed in 70 eyes with primary angle-closure glaucoma in which the intraocular pressure (IOP) could not be controlled with laser or surgical iridectomy. Following GSL, the IOP was maintained at below 20 mmHg, with and without eye drops, in 34 (87%) of 39 aphakic eyes and in 13 (42%) of 31 phakic eyes. In 8 of 10 eyes, all of which were phakic and the first GSL procedure was not effective, IOP could be controlled by a second GSL procedure combined with lens extraction. Life-table analysis showed a significant difference between the probable success rate, after 5 years, between the phakic and aphakic groups. Postoperative tonographic C values showed improvement in outflow facility. However, frequently encountered complications were exudation of fibrin and minor hemorrhage. Our results suggest that a combination of GSL and extraction of the lens may be necessary to control refractory angle-closure glaucoma.

Epikeratophakia: Technique modifications and visual results compared to the national study

Twenty-eight epikeratophakia procedures have been performed at the University of Minnesota since December 1985. This report describes several technique modifications and compares the refractive and visual outcome of these cases with the national results. There have been 17 aphakic cases (13 adult and four pediatric), seven myopic procedures, and four keratoconus cases. Of the adult aphakic cases, 80% were within 3 diopters of emmetropia at six months, with four cases showing an undercorrection. In the myopic group, five cases showed an overcorrection at six months and all patients were within two Snellen lines or better than their preoperative best corrected vision. The, major complications included one graft removal for failure to epithelialize, an interface hematoma, and a severe overcorrection to +9.37 diopters in a myopic patient. A no-keratectomy technique was used in the aphakic and myopic groups. A variation on centering the Hessburg-Barron trephine and removing the epithelium was performed and allowed for more accurate trephine placement.

Intraocular lens implantation and high myopia

We evaluated aphakia and pseudophakia in highly myopic patients whose axial lengths were 27 mm and over. Cataract surgery alone was performed on 99 eyes (aphakic group) and intraocular lens (IOL) implantation was performed on 84 eyes (pseudophakic group). The IOL power was determined by the SRK formula and ranged from + 9.0 to + 18.5 diopters (D). There was no statistical difference in postoperative complications between the aphakic and pseudophakic groups. The postoperative aphakic refractions ranged from + 9.5 D to - 3.5 D, and the pseudophakic refractions, from + 2.5 D to -14.0 D. A visual acuity of 20/40 or better was achieved by 51% of aphakic patients and 63% of pseudophakic patients. A near visual acuity of 20/40 or better was achieved by 65% of pseudophakic patients. Seventy-three pseudophakic eyes (87%) were not corrected or were corrected with minus diopter lenses. This confirmed our opinion that there was no need to correct them for near vision. According to a postoperative questionnaire, 67% of the pseudophakic patients did not need spectacles for near vision and 93% of patients could see comfortably for daily life. In view of these results, we feel that most myopic patients are good candidates for IOL implantation.

Aphakic versus pseudophakic retinal detachments

Aphakic retinal detachments and pseudophakic retinal detachments (i.e., detachments following extracapsular cataract extraction and posterior chamber lens implant surgery) from the last 3 1/2 years were studied retrospectively. In the aphakic group, myopia (mean preoperative refraction -2.60) and intraoperative loss of vitreous (10.3%) were found to be risk factors. In the pseudophakic group, male patients predominated (21/26 = 80.8%); furthermore, myopia (mean preoperative refraction -4.60, mean axial length = 24.98 mm) was also a risk factor. Additional risk factors included intraoperative rupture of the capsule (11.5%) as well as postoperative Neodymium-YAG laser capsulotomy (34.6%). There was no appreciable difference between the two groups with regard to the type of detachment. In more than 50% of the cases, retinal tears occurred in the superior temporal quadrant. In 19.4% of the cases with pseudophakic retinal detachment, no foramen could be found; on the other hand, only in 7.7% of the cases in the aphakic group was no retinal hole seen. Surgery was anatomically successful in 92.3% of the pseudophakia cases. In the group with pseudophakic retinal detachment retinal surgery was only successful in 84.6% of the cases.

Bilateral rhegmatogenous retinal detachment.

During a 4-year period, 1978-1981, 34 patients with bilateral rhegmatogenous retinal detachment were operated on at the University Eye Hospital in Helsinki. The incidence of bilaterality in the entire detachment population was 10%, in the aphakic group it was 16%. In 24 cases (71%) the interval from the first to the second eye detachment was less than 5 years, 6 patients (18%) had bilateral detachment simultaneously. The mean age of the patients when the first eye was affected (46 years, range 6-73) was significantly younger than the mean age of those with unilateral detachment (58 years, range 6-83) (P less than 0.001). Previous eye diseases were significantly (P less than 0.01) more common in patients with bilateral than in those with unilateral detachment, but the incidences of myopia, aphakia and lattice degeneration of the retina did not differ significantly between these groups. At least one of these predisposing factors was found in 85% and two or more of them in 53% of bilateral detachments. The retina was re-attached in 80% of the 44 eyes operated on during the study period. Of the 24 eyes operated on earlier, 71% were blind (visual acuity CF 1 m or worse). The latest visual acuities in both eyes or in the better eye for all patients were: greater than or equal to 0.5 in 38%, 0.4-0.2 in 35%, 0.1-CF2 m in 12%, and less than or equal to CF1 m in 15%.

Intraocular pressure and the corneal endothelium after neodymium-YAG laser posterior capsulotomy. Relative effects of aphakia and pseudophakia.

We studied intraocular pressure (IOP) changes and specular microscopic findings in 118 consecutive neodymium-YAG laser posterior capsulotomy procedures; 37 cases were aphakic, and 81 were pseudophakic. There was a significantly greater rise in IOP one hour after Nd-YAG laser treatment in the aphakic group than in the pseudophakic group (8.2 mm Hg vs 3.5 mm Hg, respectively). At one week postoperatively, IOPs in the aphakic group were still significantly elevated over baseline levels (3.6 mm Hg), while those in the pseudophakic group had returned to baseline levels. Differences in treatment between the aphakic and pseudophakic groups in total number of pulses, average energy, and total energy did not explain the differences in IOP. No significant change in endothelial cell densities was seen between pretreatment measurements and those taken one week after Nd-YAG laser treatment.

Characteristics of rhegmatogenous retinal detachment

Characteristics of rhegmatogenous retinal detachment and its predisposing factors were studied in a consecutive series of 342 patients operated on for retinal detachment (RD) at the University Eye Hospital in Helsinki in 1978-1981. On these, 234 were pre-operatively examined and operated on by the senior author. The mean age of the patients was 52.8 +/- 1.0 (range 5.7 to 83.0) years, 49.1% were males, 50.9% females. Bilateral RD occurred in 9.9%, and another 4.7% had been treated for retinal breaks in the fellow eye. Of the main predisposing factors, myopia (greater than or equal to -1.0 D) was found in 50.6% of the phakic eyes, 23.0% of the eyes were aphakic, and lattice degeneration was found in 15.1% and trauma in 11.9% of the whole series. In the nontraumatic phakic group, lattice degeneration was present in 31.3%. In the aphakic group, 25.9% had underlying myopia and 8.1% showed lattice degeneration. The relative importance of these factors varied with age. Total RD was found in 60 eyes (17.0%), most commonly in aphakic eyes (32.1%). Macula was detached in 56.5%. Two or more retinal breaks were found in 40.9%. The type of breaks varied with age and refraction. Oral dialysis was common before the age of 20 in non-myopic phakic eyes. Between 20 and 39 years, tears and holes were equally common, and after 40 years of age tears predominated. Tears outnumbered holes both in nonmyopic and myopic eyes, most round holes were found in myopic eyes. In 11.6% of the eyes no sure retinal breaks were detected. Relation of retinal breaks to peripheral retinal degenerations was studied.

Ocular blood flow in phakic and aphakic monkey eyes

Alterations in regional ocular blood flow produced by topical epinephrine were studied in phakic and aphakic eyes of Macaca arctoides using the radioactive microsphere technique. Three isotopes were used to make sequential blood flow measurements just prior to topical epinephrine administration, 1 hr later and 3 hr later. Significant reductions of flow were found in the iris, ciliary body, and optic nerve head of both phakic and aphakic groups. Choroidal and posterior optic nerve flow decreased significantly in aphakic eyes only. Decreases in flow were maximal at 3 hr. Significant changes in retinal flow were not detected. The implications of these findings regarding epinephrine-induced aphakic cystoid macular edema and the suitability of epinephrine or its derivatives in the treatment of glaucoma are discussed.

Corneal Ulcers Associated with Extended-Wear Soft Contact Lenses

We treated nine myopic and nine aphakic eyes in patients who developed corneal ulcers while wearing extended-wear soft contact lenses. Bacteria were recovered from the corneal ulcers of 13 of 18 patients with Pseudomonas aeruginosa being the pathogen most frequently isolated. Chemical disinfection was used by seven of the nine patients with myopia and eight of the nine with aphakia. Two of nine patients in the myopic group had visual loss to 20/200 and hand movements; five of nine patients in the aphakic group had visual loss to 20/50 or worse. Invasion of the corneal stroma by bacteria may occur after breakdown of the epithelial barrier by contact lens manipulation or after chronic overnight anoxic stress. Thus, the use of soft contact lenses on an extended-wear basis may be complicated by the development of corneal ulcers. Both aphakic and myopic eyes are at risk.

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.