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IOL choice plays key role with pseudophakia/aphakia PKP candidates

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BEER YAACOV, Israel — Bag-fixated or sulcus-fixated posterior chamber IOL offers a better visual outcome than other choices for patients with pseduophakic or aphakic corneal edema who are candidates for penetrating keratoplasty, according to a study. The researchers note that IOL implantation choice is the “single most significant predictor” of VA after corneal transplant.

Yaniv Barkana, MD, and colleagues here with Assaf Harofe Medical Center analyzed medical records of 48 patients who underwent 59 penetrating keratoplasty (PKP) procedures for pseudophakic corneal edema. Variables analyzed included age, gender, presence of diabetes or cardiovascular disease, method of IOL implantation during cataract surgery, vitreous loss during cataract surgery, time between cataract and PKP surgery and maximal visual acuity reached after cataract surgery.

Mean patient age at the time of PKP was 75 years. Patients were followed for a mean of 18 months. The IOL was removed or exchanged in five procedures.

The method of IOL implantation during cataract surgery was bag fixation or sulcus fixation in 28 patients, anterior chamber IOL in 15, aphakia in three and scleral-sutured posterior chamber IOL in two.

The best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 13 patients (27%). Ambulatory vision was achieved in 32 patients. In this study, 43% of patients who had a bag-fixated or sulcus-fixated posterior chamber IOL reached a BCVA of 20/40 compared with 5% (one patient) who had an anterior chamber IOL, scleral-fixated posterior chamber IOL or were aphakic.

“After adjusting for all other variables, if a posterior chamber IOL had been implanted in the bag or sulcus during cataract surgery, the patient was 16 times more likely to reach 20/40 or better vision compared with patients undergoing all other manner of IOL implantations,” the study authors wrote in the February issue of Ophthalmology.

The authors acknowledge that their study is small, and a prospective and larger study is needed to substantiate the results.