Comparison of endoscopic-assisted and temporary keratoprosthesis-assisted vitrectomy in combat ocular trauma: experience at a tertiary eye center in Turkey

Abstract

ObjectiveThis study was performed to compare the functional and anatomical results of endoscopic-assisted and temporary keratoprosthesis (TKP)-assisted vitrectomy in patients with combat ocular trauma (COT).MethodsThe medical records of 14 severely injured eyes of 12 patients who underwent endoscopy or TKP implantation in combination with vitreoretinal surgery from 2007 to 2015 were retrospectively evaluated. The patients’ ocular history and functional and anatomic anterior and posterior segment results were analyzed.ResultsEight eyes (57%) underwent TKP-assisted vitrectomy and six eyes (43%) underwent endoscopic vitrectomy. The most common cause of COT was detonation of improvised explosive devices (72%), and the most common type of injury was an intraocular foreign body (50%). The median time from trauma to surgery and the median surgical time were significantly shorter in the endoscopy than TKP group. The postoperative functional and anatomical results were not significantly different between the two groups.ConclusionsTKP-assisted vitrectomy should be performed in eyes requiring extensive bimanual surgery. In such cases, a corneal graft must be preserved for the TKP at the end of the surgery. Endoscopy shortens the surgical time and can reduce the complication rate.

Simultaneous Vitreoretinal Surgery and Penetrating Keratoplasty without a Keratoprosthesis or Endoscopy for Vitreoretinal Disease Associated with Corneal Opacity

“…Endoscopy is sometimes adopted for vitrectomy in patients with severe corneal opacity that obscures the fundus [29][30][31]. Anatomic structure and visual function of the retina were found to be improved by 25G endoscopic vitrectomy in all studied patients with PVR and severe corneal opacity [32].…”

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

“…In terms of VA, the proportion of eyes in the literature that achieve a functional level of vision is 25-75%. 7,8,13,14,15,16,17,18…”

Endoscopic vitreoretinal surgery: principles, applications and new directions

“…Endoscopic cyclophotocoagulation can be performed after implantation [27]. In eyes with an opaque cornea following ocular trauma, endoscopic surgery can allow earlier diagnosis and treatment of occult retinal tears and detachment, shorter operation times and fewer procedures than operating microscopy with a temporary keratoprosthesis [28, 29]. Earlier treatment is particularly helpful in pediatric patients where delays can cause severe proliferative vitreoretinopathy (PVR) and amblyopia [30].…”

“…Ocular trauma can compromise media clarity thereby impairing surgical microscope ophthalmoscopy. Endoscopy bypasses this problem, permitting prompt identification and management of vitreoretinal problems and intraocular foreign bodies [29, 35–37]. Endoscopy can shorten trauma-to-surgery and surgical time.…”

“…Endoscopy can shorten trauma-to-surgery and surgical time. Its outcomes are similar to those of operating microscopy with a temporary keratoprosthesis but avoids some of the logistical issues associated with temporary implant use [29].…”