Surgical outcomes of concomitantly performed penetrating keratoplasty with intrascleral haptic fixation

Abstract

Purpose: To describe the surgical results of concomitantly performed optical penetrating keratoplasty (PKP) with glued intrascleral haptic fixation (ISHF). Methods: Retrospective review of 18 patients (15–72 years) with best-corrected visual acuity (BCVA) of ≤1/60 subjected to unilateral concomitant optical PKP with ISHF and followed up for 13.11 ± 5.83 months (6–26 months) was undertaken. Results: The most common diagnoses were failed PKP (9/18, 50%) followed by aphakic bullous keratopathy (5/18, 27%). Preoperative glaucoma, peripheral anterior synechiae (PAS), and deep vascularization were present in 7/18 (38.88%), 12/18 (61.11%), and 5/18 (27.77%) patients, respectively. Intraoperatively, concomitant procedures such as pupilloplasty and intraocular lens explant were undertaken in 5/18 (27.277%) patients and 1/18 patients (5.55%) experienced suprachoroidal hemorrhage. At final follow-up, BCVA was ≥6/60 in 50% patients (mean astigmatism: 4.79 ± 1.68D), and 55.55% cases experienced graft failure (90% failed within one year of surgery). The most common causes of graft failure were glaucoma (50%), glaucoma with rejection (20%), rejection (10%), retinal detachment (10%), and suprachoroidal hemorrhage (10%). The ODDS ratio (OR) of having graft failure with the following factors was postoperative secondary interventions (OR: 6), postoperative complications (OR: 2.25), prior failed graft (OR: 1.8), preoperative PAS (OR: 1.75), intraoperative concomitant procedures (OR: 1.5), preoperative glaucoma (OR: 1.33), previous surgeries (OR: 1.24), and deep corneal vessels (OR: 0.66). Conclusion: All patients underlying PKP combined with glued ISHF must be counseled about suboptimal surgical outcomes. Emphasis is laid on appropriate case selection and stringent follow-up during the first year after surgery. Secondary interventions should be undertaken cautiously and judiciously in these patients.

Enhanced Surgical Safety through Protective Penetrating Keratoplasty: A Retrospective Analysis of 22 Cases

“…A higher proportion of eyes in our PPK study achieved a CDVA of 0.1 or more, with a significant percentage reaching 0.5 or higher, suggesting superior visual outcomes with PPK. This improvement is notable when compared to outcomes from traditional PK, where postoperative CDVA improvements have been more modest, typically ranging from 0.01 to 0.16 and averaging around 0.07 one-year postoperation [ 23 , 26 , 27 ]. These comparative insights underscore the potential of PPK as a more effective surgical option for corneal transplantation, particularly in enhancing postoperative visual acuity.…”

Concomitant sutureless scleral fixation of intraocular lens with keratoplasty

“…Agarwal et al . [ 18 ] performed glued sSFIOL in 18 patients and reported a postoperative visual acuity of 6/60 in nine patients at 13.11 ± 5.8 m follow-up. They also reported suprachoroidal hemorrhage (1/18), RD (1/18), glaucoma (10/18), rejection (2/18), and loose sutures (1/18).…”