Clinical results of combined penetrating keratoplasty and vitreoretinal surgery

The study aimed to assess the anatomical and functional success rates of penetrating keratoplasty with temporary keratoprosthesis-assisted vitreoretinal surgery.

Methods:

This retrospective study included 15 eyes of 14 patients, recording demographic characteristics, pre-operative anterior and posterior segment pathologies, intraoperative complications, postoperative graft status, retinal attachment, and complications and evaluating anatomical and functional success rates.

Results:

The mean follow-up period was 29.8 ± 19.1(6-60) months. The most common pre-operative corneal pathology was graft abscess (7 eyes [46.7%]), and the most common diagnosis of the posterior segment was endophthalmitis (7 eyes [46.7%]). Five (33.3%) cases had visual acuity between 0.001-0.08. Pre-operative endophthalmitis was diagnosed in all five cases with anatomical failure.Conclusion: Temporary keratoprosthesis-assisted vitreoretinal surgery with penetrating keratoplasty is an effective method to treat acute/subacute pathologies of the concomitant anterior and posterior segment. However, results may vary on a case-by-case basis. Pre-operative endophthalmitis is a poor prognostic factor for long-term success.

Keywords:
Keratoplasty; penetrating; Vitreoretinal surgery; Vitrectomy;Anterior eye segment; Pre-operative period; Endophthalmitis

Case	Age/sex	Eye	Preop. VA	Preop. anterior segment diagnosis	Preop. posterior segment diagnosis	Surgery	Final VA	Final corneal graft	Final retina	Anatomical success	Follow-up (months)
1	60/F	R	LP	Traumatic corneal opacity	IVH+IOL drop	PKP+VRS+IOL ext.	LP	Clear	Attached	Obtained	12
2	58/M	R	HM	Graft failure	RD+PVR	PKP+VRS+silicon oil	LP	Clear	Attached	Obtained	36
3	51/M	R	LP	Corneal abscess	Endophthalmitis	PKP+VRS+IOL and bag ext.+silicon oil	0.08	Clear	Attached	Obtained	8
4	45/F	L	NLP	Graft abscess	Endophthalmitis	PKP+VRS+IOL and bag ext.+silicon oil	NLP	Opaque	Detached	Phthisis	8
5	56/M	R	NLP	Corneal and lens penetration	4x5 mm intraocular foreign body+ endophthalmitis	PKP+VRS+ foreign body and lens ext.+silicon oil	NLP	Clear	Attached	Pre-phthisis	28
6	80/M	R	LP	Graft abscess	Endophthalmitis	PKP+VRS+IOL and bag ext.+silicon oil	NLP	Semi-clear	Detached	Phthisis	26
7	51/M	R	0.016	PBK+central stromal opacity	IOL in the vitreous	PKP+VRS+IOL imp. in the sulcus	LP	Clear	Detached+PVR	Obtained	40
8	48/F	L	NLP	Graft abscess	Endophthalmitis	PKP+VRS+lens and bag ext.	NLP	Unable	Unable	Evisceration for re-endophthalmitis	60
9	65/F	R	HM	Graft abscess	RD+PVR	PKP+VRS+ +silicon oil	0.016	Clear	Attached	Obtained	30
10	73/M	R	LP	Graft abscess	Endophthalmitis	PKP+VRS+ +silicon oil	0.03	Clear	Attached	Obtained
11	70/F	R	HM	Graft failure	İVH+ tractional PDR	PKP+VRS+ +silicon oil	0.05	Edematous	Attached	Obtained	48
12	70/F	L	HM	Graft failure	İVH+ tractional PDR	PKP+VRS+ +silicon oil	0.03	Semi-clear	Attached	Obtained	50
13	9/M	R	LP	Traumatic corneal opacity	RD+PVR	PKP+VRS+ ISF 3-piece IOL imp.+silicon oil	LP	Clear	Attached	Obtained	6
14	13/M	L	NLP	Graft abscess	Endophthalmitis	PKP+VRS+ +silicon oil	NLP	Semi-clear	Attached	Prephthisis	30
15	60/M	R	LP	Graft abscess	Endophthalmitis	PKP+VRS+ +silicon oil	NLP	Clear	Detached	Obtained	6

Lens/capsule status	Number (%)
IOL drop	2 (13.3%)
TSF-IOL	1 (6.7%)
IOL in the bag	7 (46.7%)
Phakic lens/capsule damaged	2 (13.3%)
Aphakic	3 (20%)

Postoperative complications	Number (%)
Graft failure	7 (46.7%)
Retinal detachment	3 (20%)
Glaucoma	7 (46.7%)
Keratitis	1 (6.7%)
Recurrence of endophthalmitis	1 (6.7%)
Prephthisis/Phthisis	4 (26.7%)

Conselho Brasileiro de Oftalmologia Rua Casa do Ator, 1117 - cj.21, 04546-004 São Paulo SP Brazil, Tel: 55 11 - 3266-4000, Fax: 55 11- 3171-0953 - São Paulo - SP - Brazil
E-mail: abo@cbo.com.br

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[1] Corresponding author: Burcu Kasım. E-mail: burcukasim@gmail.com