Wide-Field Landers Temporary Keratoprosthesis in Severe Ocular Trauma: Functional and Anatomical Results after One Year

Abstract

Purpose. To evaluate longitudinal functional and anatomical results after combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PKP) using a wide-field Landers intraoperative temporary keratoprosthesis (TKP) in patients with vitreoretinal pathology and corneal opacity due to severe ocular trauma. Material and Methods. Medical records of 12 patients who had undergone PPV/PKP/KP due to severe eye trauma were analyzed. Functional (best-corrected visual acuity) and anatomic outcomes (clarity of the corneal graft, retinal attachment, and intraocular pressure) were assessed during the follow-up (mean 16 months). Results. Final visual acuities varied from NLP to CF to 2 m. Visual acuity improved in 7 cases, was unchanged in 4 eyes, and worsened in 1 eye. The corneal graft was transparent during the follow-up in 3 cases and graft failure was observed in 9 eyes. Silicone oil was used as a tamponade in all cases and retina was reattached in 92% of cases. Conclusions. Combined PPV and PKP with the use of wide-field Landers TKP allowed for surgical intervention in patients with vitreoretinal pathology coexisting with corneal wound. Although retina was attached in most of the cases, corneal graft survived only in one-fourth of patients and final visual acuities were poor.

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

“…Glaucoma and graft rejection occur less frequently. 3,7,8,14,19,20 In our case series, hypotony occurred in 3 eyes, graft failure in 2 eyes, and graft rejection in 1 eye. One eye developed PVR and another exhibited macular atrophy.…”

“…2 Another alternative, Eckardt keratoprostheses, are made of silicone but were not superior to the Landers keratoprosthesis because they lacked durability over multiple uses. 3…”

Management and Treatment Outcomes of High-Risk Corneal Transplantations

“…Some studies prove penetrating keratoplasty combined with vitrectomy to be a safe and effective procedure [ 21 , 22 , 23 , 24 , 25 ]. However, another study showed poorer outcomes in patients with severe ocular trauma [ 26 ]. In our study, only one out of six patients required repeat keratoplasty after this procedure, but functional success was not obtained.…”

Penetrating Keratoplasty in Patients with Traumatic Corneal Scar

“…[11,12] Despite retinal re-attachment rates of 43%-92%, graft transparency of 15-75% has been reported in previous studies owing to the size of the initial trauma in retinal surgery with TKP. [7,[13][14][15][16] Postoperative insufficient visual acuity has been most commonly associated with graft failure, PVR, and secondary glaucoma, and the final visual acuity has been reported to be low. [16] In the current study, 12 of 14 eyes (85.7%) with anterior and posterior segment trauma showed a re-attached retina; 9 (64.2%) eyes had graft rejection and the visual acuity was 0.015±0.023.…”