Visual prognosis in pseudophakic corneal transplants

Although the prognosis for obtaining a clear corneal transplant after aphakic bullous keratopathy is good, many patients do not achieve good vision primarily because of macular disease. To evaluate the visual benefit of an intraocular lens on corneal transplantation, we performed a retrospective study comparing the best attained and latest visual acuities, corneal thinning patterns, endothelial cell densities, and postkeratoplasty complications in 31 patients with aphakic bullous keratopathy, 19 patients with pseuodphakic bullous keratopathy, 44 combined transplants with cataract extraction and 5 secondary lens implants at the time of keratoplasty. We found the presence of a lens provided patients with early functional visual rehabilitation. Subsequent visual acuity was equivalent in similar corneal disease categories. The presence of a lens did not produce additional endothelial cell loss, abnormal corneal thinning patterns, or increase the incidence of complications. The removal of an intraocular lens at transplant did not affect ultimate visual prognosis. We conclude that the implantation of an intraocular lens does not increase complications after keratoplasty in selected cases.