Visual acuity after penetrating keratoplasty for pseudophakic and aphakic bullous keratopathy

To identify prognostic factors that determine the visual acuity after penetrating keratoplasty (PKP) for bullous keratopathy secondary to cataract surgery.

Department of Ophthalmology, University Hospital Antwerp, Antwerp, Belgium.

Twenty-six patients who had PKP for bullous keratopathy were examined before and after surgery. The patients were divided into 3 groups: pseudophakic bullous keratopathy (PBK) after cataract extraction with implantation of a posterior chamber intraocular lens (PC IOL) (Group 1) or an anterior chamber IOL (AC IOL) (Group 2); aphakic bullous keratopathy (ABK) (Group 3). The following parameters were recorded: preoperative and postoperative visual acuity, age at the time of surgery, interval between cataract surgery and development of bullous keratopathy, presence of an AC IOL or a PC IOL, aphakia, and presence of concomitant ocular pathology.

Visual acuity improved in Group 1 (0.02 to 0.26); no visual improvement was observed in the other groups. Posterior segment damage occurred in one third of the patients in Group 1 and in all patients in the other groups. Patients with an intact posterior segment had a significantly better visual outcome. In eyes without posterior segment pathology, visual acuity improved from a mean of 0.03 (range 0 to 0.20) to a mean of 0.37 (range 0.03 to 0.90). In eyes with posterior segment pathology, no visual acuity improvement could be obtained.

The most important negative prognostic factors affecting visual acuity were the presence of concomitant ocular pathology, an AC IOL, and a long interval between surgery and the development of bullous keratopathy.