A new knotless technique for combined transscleral fixation of artificial iris, posterior chamber intraocular lens, and penetrating keratoplasty

Eye (Lond). 2019 Mar;33(3):358-362. doi: 10.1038/s41433-018-0202-4. Epub 2018 Sep 12.


Purpose: To present a new surgical technique for treating corneal opacity and aniridia with aphakia and the results in a small consecutive case series.

Methods: A three-piece acrylic intraocular lens (IOL) was attached to a customized silicone iris prosthesis and fixed with three 10-0 polypropylene sutures in a knotless technique using Z-sutures after trephination of the recipient cornea. The medical records of all consecutive patients who had received a keratoplasty and an implantation of an artificial iris and IOL were reviewed.

Results: Five eyes of five patients were included in the analysis. The mean age of the patients was 46.2 years and the mean follow-up was 24.6 months. The mean best-corrected visual acuity improved from 1.36 logMAR before surgery to 0.78 logMAR after surgery during the follow-up. At the last follow-up visit, the artificial iris-IOL complex was well centered with good positioning in all cases.

Conclusions: Management of post-traumatic aniridia combined with aphakia and corneal scars or graft failure by haptic fixation of a foldable IOL on an artificial iris combined with a simultaneous keratoplasty appears to be a promising approach, which allows to correct a complex lesion with a less traumatic and faster procedure.

MeSH terms

  • Adult
  • Follow-Up Studies
  • Humans
  • Iris / injuries
  • Iris / surgery*
  • Keratoplasty, Penetrating / methods*
  • Keratoplasty, Penetrating / rehabilitation
  • Lens Implantation, Intraocular / methods*
  • Lenses, Intraocular*
  • Male
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data
  • Prostheses and Implants*
  • Suture Techniques
  • Treatment Outcome
  • Visual Acuity