Mystery Box in Penetrating Keratoplasty

Dr. Meriem Ouederni describes the surgical management of a penetrating keratoplasty case complicated by several surprises, including a damaged intraocular lens (IOL) and residual crystalline lens material. After extracting the broken IOL, there was no evidence of vitreous prolapse, so she opted to first remove the Soemmerring ring and then perform an anterior vitrectomy. Rather than perform scleral fixation, which would have been more difficult due to the hypotony and corneal opacity, Dr. Ouederni chose to use open sky iris claw implantation followed by pupilloplasty to restore the shape of the defective pupil. At 10 days follow up, the corneal graft was clear and visual acuity was 20/100. 

Financial Disclosures: Dr. Meriem Ouederni discloses no financial relationships.