Scleral Fixation Of Reper Iris-Intraocular Lens Complex And Descemet's Stripping Automated Endothelial Keratoplasty For Iatrogenic Post-Surgical Aniridia, Aphakia And Corneal Decompensation

To describe a surgical technique for a scleral fixated Reper iris-intraocular lens (i-IOL) complex followed by a Descemet's stripping automated endothelial keratoplasty (DSAEK).

Birmingham and Midland Eye Centre

A 68-year-old Caucasian female with post-surgical iatrogenic aniridia, aphakia, and a compromised cornea underwent scleral fixation of a Reper iris-IOL complex (Model C, 13-mm diameter, 3.5-mm pupillary aperture). Three limbal based self-sealing transconjunctival Hoffman pockets were created at 2, 6 and 10 o’clock to bury 5-0 Gore-Tex sutures for secure fixation. A 6-mm SICS scleral tunnel incision was used to insert the complex, preserving the already compromised cornea for potential future endothelial transplant.

At 6 weeks, the Iris-IOL complex was well-centred and stable with sutures securely buried in Hoffman pockets. At 6 months, no post-operative complications such as suture erosion, inflammation, decentration or macular oedema were observed, and cosmetic outcomes were satisfactory.

Subsequently, DSAEK was performed as the corneal decompensation progressed. Post-surgical best corrected visual acuity (BCVA) was 6/18, two months following endothelial keratoplasty.

We describe an alternative surgical technique for successful implantation of a Reper  i-IOL complex followed by endothelial keratoplasty in an eye with pre-existing aphakia, aniridia and corneal endothelial decompensation.