Outcomes Of Sequential Surgery For Bullous Keratopathy After Angle-Supported Phakic Intraocular Lens Implantation In High Myopia: Phakic Iol Removal Followed By Triple Dmek

To evaluate the outcomes of sequential surgery in cases of bullous keratopathy developed after the implantation of angle-supported phakic intraocular lenses (IOLs), including the removal of phakic IOLs followed by triple DMEK surgery performed two months later.

Retrospective observational study conducted at the Ophthalmology Department of Kartal Dr. Lütfi Kırdar City Hospital.

Five patients of six eyes with bullous keratopathy developed after the implantation of angle-supported phakic IOLs were included in the study. The phakic IOLs were first removed, and after a two-month interval, triple Descemet Membrane Endothelial Keratoplasty (DMEK) surgery was performed. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), spherical equivalent (SE), intraoperative and postoperative complications were recorded during the preoperative period and at the 1st, 3rd, 6th, 9th and 12th postoperative months.

Mean BCVA was 0.24 ± 0.12 logMAR at the at the 12-month follow-up.The mean central corneal thickness (CCT) significantly decreased to 526.34 ± 58.48 μm, while endothelial cell density (ECD) showed a 36% reduction at the 1-year time point. The mean spherical equivalent (SE) at 1 year was -2.34 ± 0.75 D. Rebubbling was required in 33% of cases. In all cases, bullous keratopathy regressed. 

The sequential approach involving phakic IOL removal followed by triple DMEK surgery provides stable and predictable refractive outcomes in patients with bullous keratopathy. However, further studies are necessary to assess the long-term safety and stability of this procedure.