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Alexandre Portmann, Julie Gueudry, Marc Muraine; Bullous keratopathy after anterior chamber phakic intraocular lens: description and descemet membrane endothelial keratoplasty (DMEK) management. Invest. Ophthalmol. Vis. Sci. 2014;55(13):998.
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© ARVO (1962-2015); The Authors (2016-present)
To describe features of bullous keratopathy after phakic anterior chamber intraocular lens implantation and their management with descemet membrane endothelial keratoplasty
A retrospective case series of 19 patients implanted with anterior chamber intraocular lens, presenting with at least a unilateral bullous keratopathy, between 2008 and 2012 in a tertiary referral center. All patients had a complete ophthalmologic examination including best corrected visual acuity (BCVA), endothelial cell count, . The main outcome was the description of bullous keratopathy after phakic intraocular lens implantation. Secondary outcome measure was pronostic of surgical management with DMEK (Descemet membrane endothelial keratoplasty) in this indication.
Thirty-seven eyes of this 19 patients had phakic lens intra-ocular implantation. 26 eyes (70,3%) presented bullous keratopathy. Seven patients (37%) had bilateral bullous keratopathy. Mean age of affected patients was 57 years. Phakic angle-supported intraocular lenses was responsible of bullous keratopathy in 24 eyes (92,3%) and iris-claw intraocular lens in two eyes (7,7%). Mean time between implantation and bullous keratopathy was 7.3 years. Twenty eyes (77%) had endothelial keratoplasty : before surgery, mean best corrected visual acuity was 1,07±0,68 LogMAR, after 6 months follow up, mean BCVA was 0.39±0,53 LogMAR. Mean endothelial cell density was. Mean endothelial cell density decreased from 2800±298 cells/mm2 before surgery to 1613±501 cells/mm2 two months after surgery, and 1195±430 cells/mm2 6 months after surgery.
This study shows high incidence of bullous keratopathy after angle-supported intraocular lens implantation. Affected patients were young with high rate of bilateral decompensation (37%). Despite endothelial keratoplasty, low endothelial cell counts suggested different mecanisms to explain the difference observed with endothelial keratoplasty in Fuch's dystrophy. Life monitoring and specially corneal periphery observation should be advised in this patients.
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