Penetrating keratoplasty and anterior chamber intraocular lens implant: Outcomes in aphakic and pseudophakic bullous keratopathy

Ceratoplastia penetrante e implante de lente intra-ocular de câmara anterior:pacientes portadores de ceratopatia bolhosa pseudofácica e afácica

SUMMARY

Concerns on anterior chamber intraocular lens (AC lOL) implantation are often raised due to the association of complications with the old-styled closed-loop AC lOL, especially those implanted in the mid-1980’s. Although those lenses are no longer marketed, there are still more than 200,000 patients with this type of lens in place in the United States. There are evidences that the new-style open-loop AC lOL may not be associated with the problems caused by closed-loop AC lOL.

We report our experience in patients with pseudophakic bullous keratopathy (PBK) and aphakic bullous keratopathy (ABK) that underwent penetrating keratoplasty (PK) associated with AC lOL exchange (pseudophakic) or secondary implantation (aphakic).

Key words:
Penetrating keratoplasty; Intraocular lens; Secondary implant; Aphakic bullous keratopathy; Pseudophakic bullous keratopathy

RESUMO

Devido às complicações associadas às lentes intra-oculares de câmara anterior do tipo “alça fechada”, muito usada nos anos 80, o uso de lente de câmara anterior tem sofrido críticas, ora relacionadas à sua influência sobre a fisiologia do endotélio, ora relacionadas ao comprometimento do seio camerular, levando à progressiva formação de sinéquias anteriores. Essa preocupação se deve ao grande número de artigos publicados relacionando às lentes de “alça fechada”, a chamada “epidemia de ceratopatia bolhosa” durante o início dos anos 90. Encontramos porém evidências na literatura desassociando as modernas lentes de câmara anterior de “alça aberta” de tais complicações.

Neste estudo reportamos nossa experiência com implante lentes de câmara anterior de “alça aberta” em pacientes portadores de ceratopatia bolhosa pseudofácica (explante com substituição) e afácica (implante secundário) em pacientes submetidos a concomitante transplante penetrante de córnea.

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• From Department of Ophthalmology of Santa Casa de São Paulo, Brazil. Department of Ophthalmology, University of California, San Francisco, USA. Department of Ophthalmology, California Pacific Medical Center, San Francisco, USA

REFERENCES

• ¹
  SMITH, P. W.; WONG, S. K.; STARK, W. J. et al. - Complications on semiflexible, closed-loop anterior chamber intraocular lenses. Arch Ophthalmol, 105: 52, 1987.
• ²
  HOFFER, K. J. - Rapid fibrosis of ORC Stableflex haptics. Am Intraoc Implant Soc. J, 10: 470, 1984.
• ³
  KOENIG, S. B.; SOLOMON, J. M. - Removal of closed-loop anterior chamber intraocular lenses during penetrating keratoplasty. Cornea, 6: 207, 1987.
• ⁴
  KORNMEHL, E. W.; STEINERT, R. F.; ODRI-CH, M. G.; STEVENS, J. B. - Penetrating keratoplasty for pseudophakic bullous keratopathy associated with closed-loop anterior chamber intraocular lenses. Ophthalmology, 97(4): 407, 1990.
• ⁵
  ZAIDMAN, G. W.; GOLDMAN, S. - A prospective study on the implantation of anterior chamber intraocular lenses during keratoplasty for pseudophakic and aphakic bullous keratopathy. Ophthalmology, 97(6): 757, 1990.
• ⁶
  COLI, A. F.; PRICE, F, W.; WHITSOM, W. E. -Intraocular lens exchange for anterior chamber intraocular lens-induced corneal endothelial damage. Ophthalmology, 100(3): 385, 1993.
• ⁷
  WARING, G. O.; STULTING, R. D.; STREET, D. - Penetrating keratoplasty for pseudophakic corneal edema with exchange of intraocular lenses. Arch Ophthalmol, 105: 58, 1987.
• ⁸
  SUGAR, A.; MEYER, R. F.; HEINDEMANN, D. et al. - Specular microscopic follow-up of comeal grafts for pseudophakic bullous keratopathy. Ophthalmology, 92: 325, 1985.
• ⁹
  APPLE, D. J.; MAMALIS, N.; LOFTFIELD, K. et al. - Complications on intraocular lenses. A historical and histopathological review. Surv Ophthalmol, 29: 1, 1984.
• ¹⁰
  SOONG, H. K.; MUSCH, D. C.; KOWAL, V. et al. - Implantation of posterior chamber intraocular lenses in the absence of lens capsule during penetrating keratoplasty. Arch Ophthalmol, 107: 660, 1989.
• ¹¹
  HASSAN, T. S.; SOONG, H. K.; SUGAR, A.; MEYER, R. F. - Implantation of Kelman-style, open-loop anterior chamber lenses during keratoplasty for aphakic and pseudophakic bullous keratopathy. Ophthalmology, 98 (6): 877, 1991.
• ¹²
  KOENIG, S. B.; McDERMOTT, M. L.; HYN-DIUK, R. A. - Penetrating keratoplasty and intraocular lens exchange for pseudophakic bullous keratopathy associated with closed-loop anterior chamber intraocular lens. Am J Ophthalmol, 108: 43, 1989.
• ¹³
  SOONK, H. K.; MEYER, R. F.; SUGAR, A. -Posterior chamber lOL implantation during keratoplasty for aphakic or pseudophakic comeal edema. Cornea, 6: 306, 1987.
• ¹⁴
  SMITH, R. E; BEATTY, R. F.; CLIFFORD, W. S. et al. - Intraocular lens selection for pseudophakic and aphakic bullous keratopathy. In Cavanaugh HD, ed. The Cornea: Transactions of The World Congress on the Cornea 111, New York, Raven Press, 1988:327-321.
• ¹⁵
  KOENIG, S. B.; APPLE, D. J.; HYNDIUK - Penetrating keratoplasty and intraocular lens exchange: open-loop anterior chamber lenses versus sutured posterior chamber lenses. Cornea 13(5): 418, 1994.
• ¹⁶
  AUFFARTH, G. U.; WESENDAHL, T. A.; BROWN, S. J. et al. - Are there accetable anterior chamber intraocular lenses for clinical use in the 1990s?. Ophthalmology, 101: 1913-22, 1994.

Publication Dates

• Publication in this collection
  Oct 1997