Penetrating keratoplasty combined with posterior Artisan® iris‐fixated intraocular lens implantation

• Published in: Acta ophthalmologica Scandinavica 2006-04, Vol.84 (2), p.197-200
• Main Authors: Dighiero, Paul, Guigou, Sébastien, Mercie, Martial, Briat, Benoit, Ellies, Pierre, Gicquel, Jean‐Jacques
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anterior Eye Segment - diagnostic imaging; Artisan; bullous keratopathy; Cell Count; Corneal Diseases - diagnostic imaging; Corneal Diseases - surgery; Endothelium, Corneal - pathology; Female; Humans; Iris - surgery; Keratoplasty, Penetrating - methods; Lens Implantation, Intraocular - methods; Lenses, Intraocular; Male; Microscopy, Acoustic; penetrating keratoplasty; Pseudophakia - diagnostic imaging; Pseudophakia - surgery; surgical technique; Tomography, Optical Coherence; Treatment Outcome; ultrasound biomicroscope (UBM); Visual Acuity
• ISSN: 1395-3907; 1600-0420
• DOI: 10.1111/j.1600-0420.2005.00573.x

. Purpose:  To present a new surgical technique combining penetrating keratoplasty and open‐sky posterior iris fixation of the Artisan® iris‐claw intraocular lens (IOL) for treatment of pseudophakic bullous keratopathy in a case series of five patients. Methods:  A graft diameter of 8.25 mm was chosen. The formerly implanted angle‐supported IOL was removed. The IOL was enclosed, entrapping a fraction of the mid‐peripheral iris within the haptics whilst being held firmly with the implantation forceps. The corneal button was sutured to the recipient bed with 10–0 nylon sutures. A specular microscope was used for making an endothelial cell count. Patients underwent an ultrasound biomicroscope (UBM) scan before and 6 months after surgery and postoperative macular oedema was assessed by optical coherence tomography (OCT). The minimum follow‐up was 12 months. Results:  Visual acuity (VA) improved in all five cases (mean best corrected VA was 0.4 postoperatively versus 1.28 preoperatively). No complications were noted. The mean endothelial cell density obtained after 1 year was 1508 cells/mm2. The UBM study showed a deep anterior chamber and an open iridocorneal angle of 360 degrees in all cases. Conclusion:  The implantation of the Artisan device behind the iris better preserves the anatomy of the anterior segment with respect to the iridocorneal angle.