A retrospective case series on clinical outcomes of sequential SFIOL with DSEK in patients with complicated bullous keratopathy

This retrospective case series reports the outcomes of sequential suture-fixated intraocular lens (SFIOL) implantation and Descemet’s stripping endothelial keratoplasty (DSEK) for complicated pseudophakic or aphakic bullous keratopathy at a tertiary eye care hospital. Eight eyes of seven patients (mean age: 45 years) were included. All had a history of multiple intraocular surgeries for childhood cataract, gunshot trauma, or blast injury. Each eye showed corneal decompensation with stromal scarring off the visual axis and a disorganized anterior chamber with unstable IOLs or aphakia. At a mean follow-up of 9.8 months, all corneas remained clear. The mean uncorrected visual acuity was 1.1 logMAR, and the best-corrected visual acuity was 0.82 logMAR. The mean central corneal thickness improved from 0.837 mm preoperatively to 0.605 mm postoperatively. One patient required rebubbling for graft displacement, and no graft rejection or infection occurred. Performing SFIOL fixation before DSEK stabilized the anterior chamber, allowed effective air tamponade, and minimized inflammation, promoting graft survival. This staged approach enabled successful lamellar grafting in complex eyes that might otherwise require penetrating keratoplasty.