Long-term outcome of combined penetrating keratoplasty and vitreoretinal surgery using temporary keratoprosthesis

Abstract

Purpose To evaluate the long-term outcome of combined penetrating keratoplasty (PKP) and vitreoretinal surgery using temporary keratoprosthesis (TKP). Methods A retrospective study of 107 eyes with coexisting corneal and vitreoretinal diseases that underwent combined PKP and vitreoretinal surgery using TKP. Corneal graft clarity, intraocular pressure, and anatomical reattachment of retina were followed. Results The mean follow-up time was 25 months, the longest being 8 years. Successful surgical outcome was defined as maintenance of clear graft, anatomic reattachment of retina, and controlled intraocular pressure. A total of 78 eyes (72.9%) fulfilled these criteria. Surgical intervention within 1 month of ocular injury was associated with higher success rate (81.9%) than intervention at 1 month or more after injury (54.3%). Success rate for reattachment of retina was 95.8% when preoperative proliferative vitreoretinal retinopathy (PVR) was absent compared with 83.1% when preoperative PVR was present. Unsatisfactory postoperative visual acuity was due to graft failure, recurrent PVR, or secondary glaucoma. Conclusion Combined PKP and vitreoretinal surgery is best performed within 1 month of ocular injury for best surgical outcome. Careful selection of cases plays an important role in reducing the risks of complications. TKP is a useful adjunct in the surgery.

Combined anterior and posterior segment injuries in children: a review

“…Hypotony and phthisis were reported in 12% [40], 18% [36], 22.6% [37], and 35% [38]. If the data of children is evaluated separately, the phthisis rate is 38%.…”

“…The rate of secondary glaucoma after surgery for combined anterior and posterior injuries varies from 3% [38] or 4% [66] to 14% [40]. In most cases, secondary glaucoma can be successfully managed by topical treatment [38,40,66].…”

Chorioretinectomy for perforating or severe intraocular foreign body injuries

“…The non-chorioretinectomy group was repaired from March 2003 to June 2006 with endolaser surrounding the retinal injury sites. A temporary keratoprosthesis (TKP) (Eckhardt 7.0 mm, Dutch Ophthalmic Research Corporation, Rotterdam, The Netherlands) followed by a penetrating keratoplasty (PK) was used in the non-chorioretinectomy group when corneal scarring or edema prevented a clear view for safe vitrectomy surgery [32]. The curved illuminated 20-gauge endolaser probe was available for five of the nonchorioretinectomy cases, and the high-intensity xenon light source was not commercially available for any of the nonchorioretinectomy cases [33].…”

Pars plana vitrectomy through the Boston Keratoprosthesis type 1

“…The first study treating posterior segment complications without the use of TKPro showed promising outcomes. 3 Our study shows that performing PPV through the Boston KPro does not cause deleterious effects on the corneal carrier or the KPro itself. It may be useful as it allows patients to benefit from a PPV without having to undergo Boston KPro removal, TKPro implantation, and then re-implantation of the Boston KPro.…”

“…The standard treatment of vitreoretinal disease in patients with opaque corneas precluding adequate visualization of the fundus has been pars plana vitrectomy (PPV) through a Temporary KPro (TKPro). This technique's short 2 and long 3,4 term outcomes have shown variable degrees of success. However, data on PPV for posterior segment disease in patients with permanent Boston KPro is scarce.…”