Penetrating keratoplasty combined with intrascleral fixation of a four-haptic intraocular lens in aphakic eyes with corneal pathology.

PURPOSE: To describe the surgical technique and evaluate the preliminary short-term outcomes of penetrating keratoplasty (PKP) combined with intrascleral fixation of a four-haptic intraocular lens (IOL) in aphakic eyes with corneal pathology and insufficient capsular support.

METHODS

This prospective case series included five consecutive patients who underwent combined PKP and intrascleral fixation of a four-haptic IOL. Four eyes had bullous keratopathy with aphakia, and one had traumatic corneal leukoma with aphakia. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), graft clarity, corneal endothelial cell density (ECD), IOL position, and complications were assessed over at least 6 months.

RESULTS

Mean BCVA improved from 3.00 ± 0.00 logMAR preoperatively to 1.04 ± 0.14 logMAR at 6 months (t = 14.37, p < 0.001). Mean IOP changed from 15.66 ± 1.98 mmHg to 16.48 ± 0.64 mmHg, without significant difference (t = 0.473, p = 0.661). No major intraoperative complications occurred. Four of five grafts remained clear. In the four measurable cases, mean ECD at 6 months was 2,445 ± 193.5 cells/mm2. All IOLs remained centered and stable.

CONCLUSION

Combined PKP and intrascleral fixation of a four-haptic IOL appears to be a feasible single-stage option for selected aphakic eyes with corneal pathology and insufficient capsular support. Favorable short-term anatomical and visual outcomes were observed, but the small sample size, lack of control group, and short follow-up limit generalizability. Larger comparative studies with longer follow-up are needed.