Penetrating keratoplasty for pseudophakic bullous keratopathy associated with closed-loop anterior chamber intraocular lenses.

Closed-loop anterior chamber intraocular lenses (AC IOLs) are associated with a high incidence of pseudophakic bullous keratopathy (PBK). The prognosis for recovery of vision with penetrating keratoplasty and the exchange of one type of AC IOL for another remains controversial. A total of 40 consecutive patients with closed-loop AC IOLs and varying degrees of PBK underwent penetrating keratoplasty, explanation of the closed-loop AC IOL, and implantation of a flexible tripod AC IOL--all done with a uniform technique. The average follow-up study was 24 months. Average preoperative visual acuity was 20/170 (range, 20/25-hand motions) and average postoperative visual acuity was 20/44 (range, 20/20-no light perception). A total of 23 eyes (57.5%) achieved a visual acuity of 20/40 or better. Eleven eyes (27.5%) had a visual acuity of 20/200 or worse. Persistent cystoid macular edema was the most frequent cause of poor vision postoperatively (4 eyes), followed by age-related macular degeneration (3 eyes) and graft rejection (2 eyes). This is the first series documenting a good visual outcome for at least 2 years after penetrating keratoplasty and exchange of a closed-loop AC IOL for a single type of flexible tripod AC IOL.