Objective:

To describe the surgical technique and evaluate the preliminary short-term outcomes of penetrating keratoplasty (PKP) combined with intrascleral fixation of a four-haptic intraocular lens (IOL) in aphakic eyes with corneal pathology and insufficient capsular support.

Approach:

• Study Design: Prospective case series including five consecutive patients undergoing combined PKP and intrascleral fixation of a four-haptic IOL.
• Patient Characteristics: Patients aged 29 to 56 years, with four eyes having bullous keratopathy and one with traumatic corneal leukoma.
• Outcome Measures: Best-corrected visual acuity (BCVA), intraocular pressure (IOP), graft clarity, corneal endothelial cell density (ECD), IOL position, and complications assessed over at least 6 months.

Key Findings:

• Mean BCVA improved from 3.00 ± 0.00 logMAR preoperatively to 1.04 ± 0.14 logMAR at 6 months (p < 0.001).
• Mean IOP changed from 15.66 ± 1.98 mmHg to 16.48 ± 0.64 mmHg, with no significant difference (p = 0.661).
• Four of five grafts remained clear after surgery.
• Mean ECD at 6 months was 2,445 ± 193.5 cells/mm2.
• All IOLs remained centered and stable.

Interpretation:

Combined PKP and intrascleral fixation of a four-haptic IOL appears to be a feasible single-stage option for selected aphakic eyes with corneal pathology and insufficient capsular support.

Limitations:

• Small sample size.
• Lack of control group.
• Short follow-up period.

Conclusion:

Favorable short-term anatomical and visual outcomes were observed, but larger comparative studies with longer follow-up are needed.