Purpose: To demonstrate techniques of iris reconstruction (pupilloplasty) at the time of penetrating keratoplasty (PKP) for a variety of pupil abnormalities, and to evaluate the effect of pupilloplasty on graft survival and visual outcome.
Design: Case-control study.
Methods: Thirty-five cases (combined PKP and pupilloplasty) and 70 controls (PKP alone) were included. Various pupil abnormalities and the surgical techniques used to correct them were reviewed and categorized. The Chi-square and Student t tests were used to compare the baseline risk factors and demographic variables between treatment and control groups. The known risk factors for corneal graft survival were analyzed by Kaplan-Meier and Cox regression methods.
Results: Twenty men and 15 women in the age range, 27 to 77 years underwent combined iris reconstruction and PKP with pseudophakic/aphakic bullous keratopathy being the most common indication. The mean follow-up duration was 39.12 months and eight (22.9%) grafts failed during follow-up. Iris reconstruction during PKP has a significant positive effect on long-term graft survival (hazard ratio 2.52; 95% CI, 1.14 to 5.57; P = .022). Patients with pupilloplasty also tended to have a better mean postoperative visual acuity compared to the control group (P = .40).
Conclusions: Iris reconstruction is a relatively simple procedure that should be performed in eyes with substantial pupil abnormalities at the time of PKP. Pupilloplasty significantly improves graft survival, renders the pupil cosmetically more acceptable, and may improve visual outcome.