Anterior Chamber Stabilization in Combined Penetrating Keratoplasty With Scleral-Sutured Posterior Chamber Intraocular Lens Implantation

“…In our case series, the cost of anterior vitrectomy and local anesthesia is less than the cost of general anesthesia and postoperative nursing. Considering the serious consequences of PVP, several modified PKP methods that can be performed under local anesthesia, such as relatively closed anterior chamber techniques or minimizing the degree and duration of an open-sky procedure, have been proposed [11,15,16]. The preoperative use of an intravenous diuretic, such as mannitol or acetazolamide, to decrease the vitreous volume has also been advocated [8].…”

Section: Discussionmentioning

confidence: 99%

“…The mean rate of endothelial cell loss 12 months after conventional PKP ranged from 27.7% to 40.9% [27,28]. In another modified PKP procedure, which changed the open-sky condition to a closed one, endothelial cell loss was almost within the normal range [15,16,29]. In all of these procedures, the donor corneal graft had been covered and sutured on top of the recipient bed before all or parts of the recipient cornea were removed from the anterior chamber [15,16,29].…”

Section: Discussionmentioning

confidence: 99%

Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty

et al. 2019

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Background: This study evaluates the clinical effects of the stepwise anterior vitrectomy on the prevention of positive vitreous pressure (PVP) during penetrating keratoplasty (PKP). Methods: PKP in conjunction with stepwise anterior vitrectomy was performed on 15 eyes of 15 patients under retrobulbar anesthesia. A preset vitrectomy trocar-cannula was inserted into the vitreous cavity before PKP. During the opening of the anterior chamber, intermittent vitrectomy and corneal incision expansion were performed alternately to keep the lens or artificial intraocular lens (IOL) and iris flat until the entirety of the pathological cornea had been dissected. The main outcome measures include visual acuity, crystalline lens rise (CLR), corneal curvature and diopter, and corneal endothelial cell loss. Results: All surgical procedures were performed successfully without any PVP-related intraoperative complications. The mean time of the stepwise vitrectomies was 3.1 ± 0.7 s, the duration of each vitrectomy was 8.1 ± 5.3 s, and the duration of the total surgery was 60.5 ± 5.3 min. The anterior segment reaction was mild and the shape of the pupil remained normal 1 day after surgery. The mean preoperative and mean 3-month postoperative CLR values were 0.48 ± 0.09 mm and-0.16 ± 0.04 mm, respectively (p \ 0.0001). The mean preoperative endothelial cell density in donor buttons was 2570 ± 171 cells/mm 2 , and the mean 6-and 12-month postoperative endothelial cell density in donor buttons was 2207 ± 127 cells/mm 2 and 2000 ± 198 cells/ mm 2 , respectively. Conclusions: The novel and stabilized PKP procedure, performed in conjunction with the stepwise anterior vitrectomy, effectively avoided the PVP during open-sky surgery.

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“…İntraoperatif komplikasyonları önlemek ve cerrahi işlemleri kolaylaştırmak için literatürde farklı teknikler tanımlanmıştır. [10][11][12][20][21][22][23] Çalışmamızda, PKP ile kombine ettiğimiz hastaların cerrahisi literatüre benzer kapalı sistem teknikler kullanıla-rak gerçekleştirilmiştir. Bu hastaların hiçbirinde ciddi (suprakoroidal hemoraji, göz içi yapıların ekspulsiyonu gibi) ameliyat komplikasyonu görülme-miştir.…”

Section: Discussionunclassified