Back to front AC IOL implantation combined with penetrating keratoplasty.

In this retrospective study a simple modification of implanting an intraocular lens into the anterior chamber during penetrating keratoplasty is presented. In 14 patients who underwent penetrating keratoplasty after cataract extraction, the intraocular lens was placed back to front in the anterior chamber so that the haptic was angled anteriorly. Postoperative follow-up was 18 months on the average. There was significant improvement in vision. All 9 patients with painful bullous keratopathy were relieved of their pain. One case of mild, transient uveitis and glaucoma and two dilated pupils were seen postoperatively. No major complications have been observed so far. This study suggests that this simple method, in some cases, might be favourable when implanting an intraocular lens during penetrating keratoplasty, in the absence of capsular support.

Epithelial downgrowth--fistula repair and keratoplasty.

Eight patients with leaking fistulas from epithelial downgrowth were repaired by various techniques. Wide excision of the fistula and replacement with a graft, followed by a conjunctival flap, proved to be the most satisfactory technique for dealing with the fistula. However, this subset of patients responded to fistula closure with a much worse secondary glaucoma than downgrowth patients in general. Fifteen patients with proven epithelial down-growth received penetrating keratoplasty. Eleven of these grafts failed within a year, but there was no regrowth of epithelium on the back of the graft in at least two patients. In spite of generally discouraging results, we recommend immediate closure of epithelialized fistula to avoid even more severe complications in the future. We also recommend keratoplasty, repeated if necessary, in severe corneal edema. Both situations may eventually require radical glaucoma surgery and/or keratoprosthesis.