Case Report
Volume 13 Issue 6 - 2022
Penetrating Keratoplasty with Yamane Intrascleral Haptic Fixation of Intraocular Lens - Can it Work?
Radhika Natarajan1*, Prabhat Nangia1 and Ekta Rishi2
1CJ Shah Cornea Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
2Sri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
*Corresponding Author: Radhika Natarajan, CJ Shah Cornea Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India.
Received: April 11, 2022; Published: May 26, 2022




Abstract

Purpose: Penetrating keratoplasty (PK) is often combined with scleral fixated intraocular lens (IOL) implantation for single stage visual rehabilitation in eyes with corneal scarring and decompensation with poor capsular support. We describe here a combination of PK with sutureless intra scleral haptic fixated intraocular lens (ISHF) implantation with the help of 27-gauge needles and flanged haptic fixation as described by Yamane., et al [1].

Methods: We performed this technique in three cases wherein we removed the host cornea first followed by adequate anterior or pars plana vitrectomy and open sky Yamane intra scleral haptic fixation (ISHF) of a three piece IOL. The donor corneal suturing was completed after the IOL haptics were exteriorised.

Results: In our experience, this technique was not time consuming which is an important advantage in open sky conditions. The IOL was very stable due to the intrascleral type of fixation. The leading haptic in two cases was noted to have protruded out from the scleral tunnel in the post operative period. One patient required a scleral patch graft after 6 months to cover the haptic while the exposed haptic was trimmed in the other patient. Extending the intra scleral tunnel length solved this issue.

Conclusion: This technique provides a viable alternative in cases where IOL fixation is required concomitantly with a PK when capsular support is poor. The procedure is quick and the IOL stability is good.

Keywords: Penetrating Keratoplasty; Scleral Fixated Intraocular Lens; Corneal Decompensation; Combined Procedure

References

  1. Yamane S., et al. “Flanged Intrascleral Intraocular Lens Fixation with Double-Needle Technique”. Ophthalmology8 (2017): 1136-1142.
  2. Price FW and Whitson WE. “Visual results of suture-fixated posterior chamber lenses during penetrating keratoplasty”. Ophthalmology8 (1989): 1234-1240.
  3. Brunette I., et al. “Penetrating keratoplasty with anterior or posterior chamber intraocular lens implantation”. Archives of Ophthalmology (Chicago, Ill.: 1960)10 (1994): 1311-1319.
  4. Gonnermann J., et al. “Visual outcomes and complications following posterior iris-claw aphakic intraocular lens implantation combined with penetrating keratoplasty”. Graefe's Archive for Clinical and Experimental Ophthalmology 4 (2013): 1151-1156.
  5. Rüfer F., et al. “Implantation of retropupillar iris claw lenses with and without combined penetrating keratoplasty”. Graefe's Archive for Clinical and Experimental Ophthalmology 4 (2009): 457-462.
  6. Prakash G., et al. “Femtosecond-assisted keratoplasty with fibrin glue-assisted sutureless posterior chamber lens implantation: new triple procedure”. Journal of Cataract and Refractive Surgery 6 (2009): 973-979.
  7. Karadag R., et al. “Trocar-Assisted, Sutureless, Scleral-Fixated Intraocular Lens Implantation Combined with Penetrating Keratoplasty”. Cornea9 (2016): 1261-1265.
  8. Sethi HS., et al. “26-G needle-assisted sutureless glueless intrascleral haptic fixation for secondary ciliary sulcus implantation of three-piece polymethylmethacrylate intraocular lens during penetrating keratoplasty”. Taiwan Journal of Ophthalmology3 (2016): 141-144.
Citation: Radhika Natarajan., et al. “Penetrating Keratoplasty with Yamane Intrascleral Haptic Fixation of Intraocular Lens - Can it Work?”. EC Ophthalmology 13.6 (2022): 24-28.

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