Small-aperture intraocular lens implantation after multiple penetrating keratoplasties secondary to penetrating ocular trauma

Introduction: The small-aperture intraocular lens (IOL) is a recently introduced IOL that can provide favorable central visual acuity in patients with irregular corneas. This case describes a patient with multiple prior penetrating keratoplasties secondary to ocular trauma that achieved a favorable outcome with the aforementioned IOL. Patient and Clinical Findings: A 66-year-old man presented with a penetrating corneal injury that was successfully repaired but was eventually complicated by fungal keratitis requiring a therapeutic penetrating keratoplasty (PKP). The patient had a prolonged postoperative course complicated by multiple graft failures and finally stabilized after a third PKP. Through the protracted course, the patient developed a brunescent cataract, and the multiple PKPs resulted in significant irregular astigmatism. Diagnosis, Intervention, and Outcomes: The patient underwent cataract surgery in the affected eye with implantation of a small-aperture IOL 18 months after his initial injury. The patient's uncorrected distance visual acuity was 20/20 at six months post-operatively and he reported excellent quality of vision. Conclusions: This case represents the first use of the small-aperture IOL in a patient with prior PKP since its U.S. Food and Drug Administration approval. The small-aperture IOL can overcome high levels of corneal irregularities and provide favorable visual acuity in complex eyes.