Penetrating keratoplasty and aniridia correcting scleral fixation intraocular lens implantation after ocular trauma

INTRODUCTION: To evaluate the long-term outcomes of simultaneous or sequential penetrating keratoplasty (PK) and aniridia-correcting scleral fixation intraocular lens (aSF-IOL) implantation in eyes with traumatic keratopathy, aniridia, and aphakia/cataract.
METHODS: Five cases with corneoscleral perforation, loss of lens clarity or integrity, and iris dehiscence following trauma were included. One patient had a history of prior PK due to corneal dystrophy. In all cases, the retina was attached on echography. No foreign bodies were detected on computed tomography imaging.
RESULTS: PK and aSF-IOL (Morcher GmBH in two patients, Ophtec in two patients, and Reper in one patient) implantation were planned for each patient. Surgeries were performed sequentially in 3 eyes and simultaneously in 2 eyes. Postoperatively, best-corrected visual acuity ranged from hand motion to 0.7, with a refractive spherical equivalent ranging from -0.75 D to -4.75 D. In one case, the scleral sutures of the aSF-IOL became exposed 1 year postoperatively and were subsequently covered with pericardial tissue. In the same case, a postoperative graft rejection episode was controlled with medical treatment without loss of vision. No cases of permanent glaucoma or graft endothelial decompensation were observed postoperatively. Low visual acuity in 2 eyes was attributed to the sequelae of traumatic macular hemorrhage and optic neuropathy.
DISCUSSION AND CONCLUSION: In cases of lens loss and aniridia secondary to corneoscleral perforation, simultaneous or sequential PK and aSF-IOL implantation appears to be an effective method for visual and cosmetic rehabilitation.

Keywords: Aniridia, scleral fixation intraocular lens, traumatic aphakic keratopathy.