Indications and Results of Emergency Penetrating Keratoplasty With Simultaneous Cataract Surgery (“Triple-PKP à Chaud”)

Berger, Tim; Seitz, Berthold; Flockerzi, Elias; Suffo, Shady; Daas, Loay

doi:10.1097/ico.0000000000003035

Cited by 10 publications

(3 citation statements)

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“…However, it is equally crucial to avoid unnecessary procedures as they may increase inflammation and post-operative complication rates. Berger et al have emphasized that PK with simultaneous cataract surgery should be reserved for severely diseased eyes with an advanced stage of cataract ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Tectonic and Therapeutic Urgent Penetrating Keratoplasty Outcomes

Yilmaz

2024

Beyoglu Eye J

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Objectives: It was aimed to to provide a comprehensive assessment of therapeutic and tectonic emergency keratoplasty procedures, along with a discussion on their indications, prognostic factors for functional success, and postoperative outcomes. Methods: Patients who underwent therapeutic or tectonic Penetrating Keratoplasty (PKP) procedures between 2010 to 2021 in our hospital were retrospectively reviewed. Patient files were evaluated in terms of demographic characteristics, medical and ocular history, visual acuity, initial ocular findings, presence of glaucoma, causative microorganisms, details of surgical procedures, complications, graft transparency and globe integrity. Visual acuity was measured as light perception, hand motion, counting finger, Snellen chart and subsequently converted to Logarithm of the Minimum Angle of Resolution (logMAR) for statistical analysis. Results: The study included a total of 43 patients, with 16 (37.2%) being female. The average age of the participants was 59.72±18.1 years. The corrected distance visual acuity improved from 2.3±0.66 logMAR preoperatively to 1.72±1.02 logMAR postoperatively (p=0.001). After PKP, anatomical success was achieved in all eyes and functional success was achieved in 23 (51.1%) eyes. It was observed that only preoperative glaucoma had a significant impact on graft survival rate (p=0.002, Figure 2), as well as functional success (p=0.022). Conclusion: Urgent keratoplasty is a viable treatment option for cases involving an actively uncontrolled infection or corneal disease with perforation. In cases of graft rejection, bacteria, fungi, and viral pathogens were detected as causative agents, whereas only bacteria were detected as the causative agents in cases of pre and post-operative endophthalmitis. Early diagnosis and treatment play crucial roles in achieving anatomical and functional success.

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Section: Discussionmentioning

confidence: 99%

Tectonic and Therapeutic Urgent Penetrating Keratoplasty Outcomes

Yilmaz

2024

Beyoglu Eye J

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“…Before deciding on additional surgical procedures like an emergency penetrating keratoplasty [16], diagnostic imaging modal-ities to rule out a tumor are advised in cases with uncertain origin of a corneal perforation. Nevertheless, primary enucleation for corneal perforation should be performed only in a hopeless situation and in pathologies that do not allow a preservation of the eye [16,17]. Especially in choroidal melanomas, it is important to deeply dissect the optic nerve during enucleation, because tumorous infiltration cannot be excluded [18].…”

Section: Discussionmentioning

confidence: 99%

Corneal Perforation as a Rare and Late Manifestation of Choroidal Melanoma

Berger

Flockerzi

Löw

et al. 2023

Klin Monbl Augenheilkd

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Purpose To report a case of corneal perforation as a rare and late manifestation of choroidal melanoma and to highlight the major histopathological findings of this unusual combined clinical presentation. Methods A 74-year-old male patient presented to our department due to corneal perforation of the right eye with the absence of light perception for 6 months. The intraocular pressure was hard on palpation. Because of the protracted finding and reduced visual prognosis, primary enucleation was performed. Results The histopathological examination revealed choroidal melanoma with epithelioid and spindle cell components at the posterior pole, which was positive for Melan-A, Human Melanoma Black 45 (HMB45), BAP1, and SOX10. The anterior segment showed complete anterior chamber hemorrhage and blood remnants in the trabecular meshwork. The cornea displayed diffuse blood staining with hemosiderin and hemosiderin-loaded macrophages and keratocytes. No inflammatory cells were present near the corneal perforation, which had a width of 3 mm. Intraocular heterotopic ossification was indicative of a long-standing condition. Postoperative cancer staging was normal. Conclusion Corneal perforation should be considered as a very rare and late manifestation of advanced choroidal melanoma and may result from interaction between intraocular hemorrhage, elevated IOP, and its secondary signs such as corneal blood staining.

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“…mit simultaner Operation der Linse (sog. Triple-PKP à chaud) 19 . Sollte nicht unmittelbar Hornhautgewebe zur Verfügung stehen und die Perforation klein genug sein (in der Regel < 1 mm), kann eine Hornhautklebung mit Histoacryl-Kleber durchgeführt werden, um später eine elektive PKP zu ermöglichen 20 .…”

Section: Therapieunclassified

Hornhautulkus – Handlungspfad

Hamon¹,

Daas²,

Seitz³

2022

Augenheilkunde up2date

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Hornhautulzera können die anatomische Integrität der Augenoberfläche oder die Transparenz der Hornhaut schnell gefährden und zu einem tiefen und dauerhaften Verlust des Visus führen. Die ätiologische Diagnose ist vielfältig und nicht immer einfach. Es ist jedoch wichtig, schnell zwischen einer infektiösen, entzündlichen oder trophischen Ursache zu unterscheiden, da sie über das adäquate therapeutische Vorgehen entscheidet.

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Indications and Results of Emergency Penetrating Keratoplasty With Simultaneous Cataract Surgery (“Triple-PKP à Chaud”)

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 10 publications

References 50 publications

Tectonic and Therapeutic Urgent Penetrating Keratoplasty Outcomes

Tectonic and Therapeutic Urgent Penetrating Keratoplasty Outcomes

Corneal Perforation as a Rare and Late Manifestation of Choroidal Melanoma

Hornhautulkus – Handlungspfad

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