Comparison of the Techniques of Secondary Intraocular Lens Implantation after Penetrating Keratoplasty

Abstract

Aim: To conduct a retrospective analysis of secondary IOL implantation in patients who underwent PK with no simultaneous IOL implantation.

Materials and methods: The retrospective study of the secondary implantation of IOLs was conducted in 46 eyes that underwent a primary operation with PK and cataract/lens extraction with no IOL implantation due to capsule rupture or combining corneal or intraocular complications. The minimum period from PK was 12 months. All secondary IOL implantations were performed from January 2011 to August 2017. Aphakic postkeratoplasty patients were treated using one of the surgical techniques for secondary IOL implantation. In-the-bag IOL implantation was possible if the posterior capsule was complete. If the lens capsule remnants were sufficient to provide secure IOL support, an in-the-sulcus IOL implantation was performed. Scleral fixation was offered in eyes with extensive capsular deficiency or the presence of the vitreous body in anterior chamber. BCVA and expected and achieved refraction were evaluated; we included using two biometry devices, and results were compared.

Results: The corrected distance visual acuity (CDVA) before surgery ranged from 0.1 to 0.8 (mean 0.54 ± 0.17). After secondary IOL implantation, CDVA ranged from 0.2 to 0.8 (mean 0.43 ± 0.14) at postoperative 1 month and from 0.3 to 0.9 (mean 0.55 ± 0.15) at postoperative 6 months (p < 0.05). Comparison of the final refraction using two methods of biometry showed no statistically significant difference in the group that underwent scleral fixation of the IOL, similar to the findings for the in-the-bag and in-the-sulcus IOL implantation groups. In the scleral-fixation group, p=0.55 for the USG biometry technique and p=0.22 for the OB technique. p values for the IOL-implantation group were p=0.49 and p=0.44, respectively.

Conclusion: Both implantation methods are safe for the patients. Final refraction is depending on the technique and indication to keratoplasty. Both biometry techniques deliver precise data for IOL choice.

Figure 1

Corrected distance visual acuity at major points before IOL implantation, 1 month after surgery, and 6 months after surgery.

Figure 2

Corrected distance visual acuity. Series 1: before IOL implantation; series 2 : 1 month after surgery; series 3 : 3 months after in-the-bag and in-the-sulcus IOL implantation surgery.

Figure 3

Corrected distance visual acuity. Series 1: before IOL implantation; series 2 : 1 month after surgery; series 3 : 3 months after scleral fixation surgery of the IOL.

Figure 4

Bland–Altman tests showing the mean difference between the achieved and expected final refraction and the mean refraction in the ultrasound biometry measurement group (a) and the optical biometry measurement group (b).

Figure 5

The difference between the expected and achieved refraction for both measurement methods with a myopic shift in the ultrasound biometry measurement group (a) and the optical biometry measurement group (b) (p < 0.05).

Figure 6

Final corrected distance visual acuity—surgical method comparison (p=0.12).

Figure 7

The difference between expected and achieved refraction in both measurement methods with myopic shift in the ultrasound biometry measurement group (a) and the optical biometry measurement group (b) (p < 0.05). USG_expected_impl: USB expected refraction; USG_achieved_IMPL: USG achieved refraction; USG_exp._fix.: USG expected refraction; USG_achieved_FIX.: USG achieved refraction; OB_exp._impl.: OB expected refraction; OB_achieved_IMPL: OB achieved refraction; OB_exp._fix.: OB expected refraction; OB_achieved_FIX: OB achieved refraction.