{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:51:14Z","timestamp":1782449474690,"version":"3.54.5"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To describe the surgical technique and evaluate the preliminary short-term outcomes of penetrating keratoplasty (PKP) combined with intrascleral fixation of a four-haptic intraocular lens (IOL) in aphakic eyes with corneal pathology and insufficient capsular support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective case series included five consecutive patients who underwent combined PKP and intrascleral fixation of a four-haptic IOL. Four eyes had bullous keratopathy with aphakia, and one had traumatic corneal leukoma with aphakia. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), graft clarity, corneal endothelial cell density (ECD), IOL position, and complications were assessed over at least 6\u202fmonths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean BCVA improved from 3.00\u202f\u00b1\u202f0.00 logMAR preoperatively to 1.04\u202f\u00b1\u202f0.14 logMAR at 6\u202fmonths (\n                      <jats:italic>t<\/jats:italic>\n                      \u202f=\u202f14.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Mean IOP changed from 15.66\u202f\u00b1\u202f1.98\u202fmmHg to 16.48\u202f\u00b1\u202f0.64\u202fmmHg, without significant difference (\n                      <jats:italic>t<\/jats:italic>\n                      \u202f=\u202f0.473,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.661). No major intraoperative complications occurred. Four of five grafts remained clear. In the four measurable cases, mean ECD at 6\u202fmonths was 2,445\u202f\u00b1\u202f193.5 cells\/mm\n                      <jats:sup>2<\/jats:sup>\n                      . All IOLs remained centered and stable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Combined PKP and intrascleral fixation of a four-haptic IOL appears to be a feasible single-stage option for selected aphakic eyes with corneal pathology and insufficient capsular support. Favorable short-term anatomical and visual outcomes were observed, but the small sample size, lack of control group, and short follow-up limit generalizability. Larger comparative studies with longer follow-up are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1861508","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:35:43Z","timestamp":1782448543000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Penetrating keratoplasty combined with intrascleral fixation of a four-haptic intraocular lens in aphakic eyes with corneal pathology"],"prefix":"10.3389","volume":"13","author":[{"given":"Chang","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Department of Ophthalmology, Xiangyang Central Hospital","place":["Xiangyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuying","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochun","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Xiangyang Central Hospital","place":["Xiangyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guigang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]},{"name":"Hubei Key Laboratory of Otolaryngologic and Ophthalmic Diseases, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3142","DOI":"10.4103\/IJO.IJO_1942_23","article-title":"Corneal blindness and eye banking: current strategies and best practices","volume":"71","author":"Anitha","year":"2023","journal-title":"Indian J 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Ophthalmol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1097\/ICO.0000000000000944","article-title":"Trocar-assisted, sutureless, scleral-fixated intraocular lens implantation combined with penetrating keratoplasty","volume":"35","author":"Karadag","year":"2016","journal-title":"Cornea"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1016\/S0886-3350(97)80214-3","article-title":"Cataract formation after penetrating keratoplasty","volume":"23","author":"Rathi","year":"1997","journal-title":"J Cataract Refract Surg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.ajo.2007.10.006","article-title":"Iris reconstruction in penetrating keratoplasty\u2014surgical techniques and a case-control study to evaluate effect on graft survival","volume":"145","author":"Arundhati","year":"","journal-title":"Am J Ophthalmol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1097\/j.jcrs.0000000000000907","article-title":"Toric intraocular lenses for astigmatism correction after keratoplasty in phakic and pseudophakic eyes","volume":"48","author":"Wan","year":"2022","journal-title":"J Cataract Refract Surg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1007\/s12325-019-01139-6","article-title":"Stepwise decreasing of vitreous pressure by anterior vitrectomy: a novel method for preventing positive vitreous pressure during penetrating keratoplasty","volume":"37","author":"Huang","year":"2020","journal-title":"Adv Ther"}],"container-title":["Frontiers in 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