Transsclerally-fixated posterior chamber intraocular implants without capsular support in penetrating keratoplasty

The results of 36 patients who underwent penetrating keratoplasty with transscleral fixation of a posterior chamber intraocular lens are reviewed. A 13.75-millimeter "Revlens," which has the configuration of an open-loop anterior chamber lens, was used in all of the cases and gave good stability in the ciliary sulcus. The 10-0 Prolene sutures used to secure the implants were burrowed through the sclera and exited sufficiently far from the limbus to be adequately covered by Tenon's capsule and conjunctiva. No sutures eroded through the conjunctiva or needed to be removed. Two grafts became opaque, one from rejection and the other from uncontrolled glaucoma. No vitreous hemorrhage or retinal detachment occurred. Ten patients (27.8%) had cystoid macular edema diagnosed either before or after surgery; three had age-related macular degeneration; and two had traumatic macular scars. Sixteen eyes (44.4%) had final visual acuities of 20/40 or better and 25 (69.4%) saw 20/200 or better. Mean follow up was 16.8 months (range, 9 to 36 months).