Bullous Keratopathy with Late Onset Following Iris-Fixated pIOL Surgery

Overview

This case study presents a patient who developed bullous keratopathy requiring keratoplasty more than a decade after bilateral anterior chamber phakic intraocular lens (AC pIOL) implantation.

Background

Phakic intraocular lenses (pIOLs) are used to correct severe refractive errors while preserving the natural lens. They are associated with complications such as intraocular pressure elevation and corneal endothelial cell loss.

Data Highlights

No numerical data or trial data presented in the article.

Key Findings

• A 32-year-old woman developed bullous keratopathy 12 years post AC pIOL implantation.
• Endothelial cell density (ECD) decreased from 2770 cells/mm² to 513 cells/mm² in the left eye prior to explantation.
• Following pIOL explantation, the patient underwent Descemet Membrane Endothelial Keratoplasty (DMEK) for corneal decompensation.
• Post-operative visual acuity improved to 6/7.5 in the left eye after DMEK.
• Endothelial cell recovery was noted with ECD of 2410 cells/mm² in the left eye at 9 months post-surgery.

Clinical Implications

This case underscores the importance of long-term follow-up for patients with AC pIOLs, particularly monitoring for endothelial cell loss. Clinicians should consider the potential for late-onset complications when evaluating pIOL candidates.

Conclusion

The case illustrates the delayed onset of bullous keratopathy following AC pIOL surgery.

Related Resources & Content

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9. https://www.nature.com/articles/s41598-025-14330-3.pdf
10. Contact Lens-Assisted DMEK for Corneal Decompensation With an Anterior Chamber Intraocular Lens: A Novel Technique - PubMed
11. ESCRS:When Is It Time to Remove a Phakic IOL?