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Purpose: To compare the outcomes of patients who underwent penetrating keratoplasty (PK) and transscleral sutured posterior chamber intraocular lens (TS PCIOL) implantation by using insideout (open-sky) technique with scleral flap or scleral burial. Methods: Data from all patients who had PK-TS PCIOL performed by the same surgeon (B.Y) between April 2004 and December 2013 were compiled. Fifty six eyes of 55 patients were analyzed. The patients were split into 2 groups: Group F (flap) consisted of 34 eyes of 33 patients who had PK-TS PCIOL with 10/0 prolene sutures. Scleral fixation knots were covered with a triangular scleral flap in those patients. Group B (burial) consisted of 22 eyes of 22 patients who had PK-TS PCIOL with 9/0 prolene sutures. In those patients, suture ends were buried into the sclera by using Baykara technique. Results: Mean age was 58.0 ± 17.1 years, follow-up 19.9 ± 9.2 months in group F, 61.4 ± 15.2 and 18.1 ± 7.5 respectively in group B. Mean logMAR best spectacle-corrected visual acuity improved from 2.75 ± 0.51 to 1.59 ± 0.87 in group F (p<0.000), from 2.86 ± 0.47 to 1.35 ± 0.85 in group B postoperatively (p<0.000). Vitreous hemorrhage occurred in 7 eyes (20.6%) in group F, 2 eyes (9.1%) in group B. Seven suture erosion (20.6%) occurred in group F, none (0.0%) in group B. Postoperative IOP elevation in 10 eyes (29.4%) in group F, 11 eyes (50.0%) in group B. That elevation was statistically significant in group B (p=0.008). Graft survival rate at one year was 85.3% and 95.5% respectively (p=0.358). Cystoid macular edema was observed in 2 eyes of both groups. There were no dislocation, lens tilting, suture breakage or retinal detachment. Conclusions: Scleral burial of prolene sutures during PK-TS PCIOL prevents exposure, shortens the surgical time and improves outcomes. However IOP should be monitored closely.

international journal of ophthalmology and clinical research

Retrospective Comparison of Scleral Flap and Scleral Burial Techniques to Fixate A Scleral Sutured Intraocular Lens Concurrently with Penetrating Keratoplasty