Penetrating keratoplasty combined with posterior Artisan iris-fixated intraocular lens implantation.

PURPOSE To present a new surgical technique combining penetrating keratoplasty and open-sky posterior iris fixation of the Artisan iris-claw intraocular lens (IOL) for treatment of pseudophakic bullous keratopathy in a case series of five patients. METHODS A graft diameter of 8.25 mm was chosen. The formerly implanted angle-supported IOL was removed. The IOL was enclosed, entrapping a fraction of the mid-peripheral iris within the haptics whilst being held firmly with the implantation forceps. The corneal button was sutured to the recipient bed with 10-0 nylon sutures. A specular microscope was used for making an endothelial cell count. Patients underwent an ultrasound biomicroscope (UBM) scan before and 6 months after surgery and postoperative macular oedema was assessed by optical coherence tomography (OCT). The minimum follow-up was 12 months. RESULTS Visual acuity (VA) improved in all five cases (mean best corrected VA was 0.4 postoperatively versus 1.28 preoperatively). No complications were noted. The mean endothelial cell density obtained after 1 year was 1508 cells/mm(2). The UBM study showed a deep anterior chamber and an open iridocorneal angle of 360 degrees in all cases. CONCLUSION The implantation of the Artisan device behind the iris better preserves the anatomy of the anterior segment with respect to the iridocorneal angle.