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K. C. Sippel; Techniques in Permanent Keratoprosthesis Surgery: Intraoperative Dexamethasone May Predispose to Postoperative Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1897.
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Permanent keratoprosthesis surgery has become increasingly successful in recent years in the reconstruction of eyes with advanced corneal pathology. However, vitreous hemorrhage in the immediate postoperative period is a relatively common occurence and delays visual recovery in these frequently monocular patients. Intraocular steroid injection to minimize postoperative inflammation has been part of the standard end-of surgery regimen in these patients, and the influence on postoperative inflammation was investigated.
A retrospective review of patients undergoing permanent keratoprosthesis placement with the Boston keratoprosthesis was performed, and the relationship of intraoperative intracameral dexamethasone injection to postoperative vitreous hemorrhage tabulated.
14 patients underwent surgery for a typical variety of indications for keratoprosthesis placement, and 6 received dexamethasone and 8 did not. Two patients in the dexamethasone group developed substantial postoperative vitreous hemorrhage, while no vitreous hemorrhage occurred in the uninjected group. Postoperative inflammation was minimal and equal in the two groups.
While the available data are clearly inconclusive. there is a trend toward an increased risk of postoperative hemorrhage in those patients receiving intracameral dexamethasone at the conclusion of keratoprosthesis surgery. Given the similarity in postoperative inflammation between the two groups, the routine use of this medication has been discontinued, and data collection will continue.
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