Clinical Results in Patients with Combined Penetrating Keratoplasty and Vitreoretinal Surgery Using Landers Wide-field Temporary Keratoprosthesis

Abstract

Objectives:To evaluate the clinical results of combined pars plana vitrectomy (PPV) with Landers wide-field temporary keratoprosthesis and penetrating keratoplasty (PK).Materials and Methods:From January 2016, traumatic eyes with coexisting corneal and vitreoretinal diseases that underwent combined keratoprosthesis/PPV/PK surgery were retrospectively evaluated. Demographic characteristics, visual acuity (VA), intraocular pressure (IOP) and clinical findings of the cornea, lens, and retina were recorded during the follow-up. Cases with clear corneal graft, attached retina, normotonic IOP, and improved or stable VA were considered successful.Results:Eight eyes were enrolled in the study. The mean follow-up time was 21.1±8.20 months. Surgery was performed a mean of 23 (10-40) days after trauma. Preoperative VA ranged from no light perception to counting fingers from 50 cm. Postoperatively, corneal graft was clear in 5 patients (62.5%) and retina was attached in 6 eyes (75%). Chronic hypotonia developed in 3 patients (37.5%). VA was unchanged in 3 patients and improved in 5 patients. A total of 5 cases (50%) were considered successful. Shorter interval between trauma and surgery was associated with higher likelihood of success (p=0.043). No significant difference was observed between the groups in terms of type or location of trauma (p=1; p=0.143).Conclusion:Although the functional results are not very satisfactory, the combined procedure provides a final opportunity for preserving remaining vision and anatomic reconstruction in eyes that will otherwise result in phthisis due to severe anterior and posterior segment pathologies.

Graft Outcomes After Temporary Keratoprosthesis in Combined Penetrating Keratoplasty and Vitreoretinal Surgery

“…Mayalı et al 26 conducted a study in which SO tamponade was used in all patients during combined surgery. Contrary to our results, however, they reported that SO did not significantly increase the risk of graft failure.…”

“…This may be explained by a variety of factors, including a large percentage of their patients having a postoperative pseudophakic status that could have reduced the probability of direct SO-endothelium contact, early removal of SO, and small sample size. 26 In addition, Watson et al 16 described a nonsignificant trend toward early graft failure in SO-filled eyes, and Lee et al 11 reported no significant effect of SO on graft survival. However, both discussed the benefits of further studies with longer follow-up and larger sample sizes.…”

Pars plana vitrectomy and therapeutic keratoplasty in endophthalmitis and infectious keratitis

“…In pathologies in which corneal and vitreoretinal pathologies coexist, the use of temporary keratoprosthesis (TKP) grants a clear view during pars plana vitrectomy (PPV), providing the same surgical properties as the standard vitreoretinal sur­gery. 5,6 The first TKP for PPV was described by Landers 7 who designed the wide-field TKP used nowadays. 8…”

“…[2][3][4] In pathologies in which corneal and vitreoretinal pathologies coexist, the use of temporary keratoprosthesis (TKP) grants a clear view during pars plana vitrectomy (PPV), providing the same surgical properties as the standard vitreoretinal surgery. 5,6 The first TKP for PPV was described by Landers 7 who designed the wide-field TKP used nowadays. 8 PK with PPV assisted by TKP has shown its advantages in ocular trauma and endophthalmitis cases, but the majority of the published studies include a limited number of infectious conditions.…”

Clinical Outcomes of Patients with Combined Penetrating Keratoplasty and Pars Plana Vitrectomy Surgery Using Eckardt Temporary Keratoprosthesis: Retrospective Study

“…Significant disparities, particularly in terms of corneal graft survival, functional success, and complication rates, have been observed. [6][7][8] As each patient and case is unique, treatment options should be tailored to the patient's specific condition. In light of these considerations, this study examines the clinical characteristics and outcomes of patients who underwent combined PKP and PPV with the use of the Eckardt TKP.…”