Background: One of the options the surgeon has, in the absence of lens capsule in an eye to be rendered pseudophakic, is a transsclerally sutured posterior chamber intraocular lens. This procedure can be combined with penetrating keratoplasty, in aphakic or pseudophakic covered edema.

Methods: We studied retrospectively the results of the first 10 cases of bullous keratopathy in which we performed penetrating keratoplasty combined with transsclerally suture fixated intraocular lenses.

Results: Nine grafts remained transparent and 1 became opaque due to graft rejection with a mean follow up of 26.4 months. Postoperative visual acuity was improved in 7 eyes, remained the same in 2 and became worse in 1 (graft rejection) The poor postoperative visual acuity in 2 eyes was attributed to cystoid macular edema. All sutured intraocular lenses remained in situ; there was no apparent degradation of the Prolene suture. Two eyes developed postoperative medically controlled glaucoma.

Conclusions: Intraocular lens scleral fixation with sutures, combined with penetrating keratoplasty, seems to be a good procedure for visual rehabilitation for aphakic or pseudophakic bullous keratopathy.