Intraocular Lens Exchange And Artificial Iris Implantation With Following Photorefractive Keratectomy In A Post-Penetrating Keratoplasty Combined With Intraocular Lens Subluxation Case- Case Report

To provide a modified and minimal invasive surgical procedure for intraocular lens exchange and artificial iris implantation in post-penetrating keratoplasty combined with intraocular lens subluxation case

A case report

A case report collected from Taipei Municipal Wan Fang Hospital in 2023

A 60 year-old female patient had ocular trauma history of left eye. She had phacoemulsification, intraocular lens(IOL) trans-scleral fixation and penetrating keratoplasty(PK) of left eye at the other hospital. She had blurred vision and photophobia of left eye after then. Traumatic aniridia, IOL subluxation and iatrogenic pigment dispersion syndrome were noted. She underwent IOL exchange with scleral fixation by GORE-TEX^® CV-8, and artificial iris implantation with 6-O polypropylene flanged fixated at sclera. After surgery, removal of PK corneal stitches and photorefractive keratectomy of left eye were done for residual astigmatism. Her visual acuity turned to 0.9 from 0.6 and was stable without symptom of photophobia.    

We introduce a modified surgical technique for traumatic aniridia, intraocular lens subluxation in a post-penetrating keratoplasty case. During the intraocular lens exchange procedure, scleral erosions at previous polypropylene flanged sites were noted. New intraocular lens was fixed by GORE-TEX^® CV-8 suture at sclera and artificial iris implantation was fixed by 6-O polypropylene flanged at sclera. Removal of penetrating keratoplasty stitches and Photorefractive keratectomy were done for residual astigmatism. Her visual acuity was improved and symptoms of photophobia was relieved. Potential complications of flanged (such as conjunctival erosion, conjunctival inflammation, flange exposure) didn't happen in one year follow-up.