Combined Therapeutic Penetrating Keratoplasty and Pars Plana Vitrectomy for the Treatment of Infectious Keratitis Endophthalmitis: Mexican Endophthalmitis Study Group Protocol 4

Abstract

Purpose:The purpose of this study was to assess the role of combined surgical treatment of therapeutic penetrating keratoplasty and pars plana vitrectomy in the anatomical and functional outcome of infectious keratitis endophthalmitis.Methods: This study reviewed the medical records of 4 participating centers in the United States and Mexico. This study included patients with a clinical diagnosis of infectious keratitis endophthalmitis who had been treated with an early therapeutic penetrating keratoplasty and pars plana vitrectomy as the main treatment for endophthalmitis. From each medical record, the study retrieved demographic data, relevant medical and drug history, baseline clinical manifestation of endophthalmitis, best-corrected visual acuity, and the need for enucleation/evisceration for the control of the infection or any other reason through the follow-up. Results:The study included 48 patients (50.15 6 20.6 years). The mean follow-up time was 13 6 0.5 months. The mean best-corrected visual acuity at baseline was 2.1 6 0.25 logarithm of the minimum angle of resolution. At month 12 was 2.09 6 0.61 logarithm of the minimum angle of resolution (P = 0.9). The overall prevalence of enucleation/evisceration was 8.3% (95% confidence interval: 2.32%-19.98%). The prevalence of a vision of no-light perception was 20.8% (95% confidence interval: 2.32%-19.98%). Conclusions:Combined surgery for severe cases of infectious keratitis endophthalmitis eradicates the infection in most cases, while significantly improving the overall outcomes.

Tectonic and Therapeutic Urgent Penetrating Keratoplasty Outcomes

“…Gumus et al stated that the absence of post-operative complications was significantly associated with functional success ( 3 ). In a study that examined cases of combined infectious keratitis and endophthalmitis, Velez-Montoya et al observed that they could not detect a significant increase in vision after combined therapeutic PK+PPV, but they achieved an initial anatomical success rate of 91.7% ( 29 ). Two of our patients presented with signs of endophthalmitis on admission, and another two patients developed endophthalmitis postoperatively.…”