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Anterior Chamber Stabilization in Combined Penetrating Keratoplasty With Scleral-Sutured Posterior Chamber Intraocular Lens Implantation

Purpose: To describe a novel technique for a stabilized penetrating keratoplasty procedure with implantation of a scleral-sutured posterior chamber intraocular lens in which the anterior chamber (AC) is maintained and the globe stabilized without using a Flieringa ring. Methods: In this procedure, a deep anterior corneal lamella separation was created. Four small incisions were made in each quadrant along the outer edge of the trephination groove of the residual stromal bed (RSB). The first incision at the 9-o'clock position was advanced with scissors in both clockwise and counterclockwise directions. This procedure was repeated in the remaining 3 quadrants, creating 4 small bridges between the RSB and corneal rim. A donor corneal button coated with a viscoelastic material was sutured at 3 incision sites leaving 1 quadrant sutureless to allow sufficient incision width for IOL insertion for scleral fixation. Scleral fixation of a 1-piece polymethyl methacrylate (PMMA) IOL was performed. After sequential cutting of the bridges, the RSB was removed from the AC. Ten eyes of 10 patients underwent this procedure without significant complications. Results: There were no complications related to the open-sky procedure. Globe stabilization was achieved in all surgeries. Endothelial cell loss, visual acuities, and graft failure rates were comparable with the reports of AC-protecting penetrating keratoplasty surgeries. Conclusions: This technique provides a secured AC and stabilized globe without the use of a Flieringa ring and increases the surgical safety without a significant reduction of the graft endothelial cell density.