Simultaneous Implantation Of Reper Artificial Iris Intraocular Lens And Penetrating Keratoplasty

To describe a surgical approach involving the simultaneous implantation of a Reper artificial iris intraocular lens (IOL) and penetrating keratoplasty in a 50-year-old male with complete corneal leucoma, aphakia, and aniridia due to trauma. The procedure aimed to restore corneal clarity and pupillary function in a single step, addressing severe post-traumatic anterior segment damage.

This case was managed at University of Messina, Ophthalmology Department. 

Preoperative assessment was limited to B-scan ultrasonography due to corneal opacity, while biometry and IOL power calculations were derived from the unaffected fellow eye. The procedure was performed under general anesthesia, utilizing an "open-sky" approach combining penetrating keratoplasty with implantation of a Reper artificial iris IOL. Three scleral fixation points were created 2 mm from the limbus at 6, 10, and 2 o’clock positions for secure IOL fixation. A donor cornea was trephined to 8 mm, and the diseased cornea was excised using a 7.75 mm trephine. The Reper artificial iris IOL was sutured using 10-0 Prolene, ensuring stability. The donor cornea was then sutured into place with 10-0 nylon, and a peripheral iridectomy was performed to prevent pupillary block. Postoperative management included topical corticosteroids, antibiotics, and cycloplegics.

Postoperative evaluation revealed a clear graft, stable IOL, and well-centered pupillary aperture. No significant complications, such as graft rejection or secondary glaucoma, were observed.

Simultaneous implantation of a Reper artificial iris IOL and penetrating keratoplasty offers a promising single-stage solution for patients with post-traumatic corneal leucoma, aphakia, and aniridia. This approach successfully restores corneal transparency, functional vision, and cosmetic appearance, reducing the need for multiple surgical interventions. Careful planning and postoperative monitoring are essential to ensure optimal outcomes.