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M Oh, EA Postel, T Kim, C Fowler; Surgical Results Following Combined Temporary Keratoprosthesis and Penetrating Keratoplasty With Pars Plana Vitrectomy for Complex Retinal Detachment With Corneal Opacity . Invest. Ophthalmol. Vis. Sci. 2002;43(13):626.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To assess anatomical and visual outcomes following pars plana vitrectomy (PPV) for complex retinal detachment in cases with corneal opacity requiring temporary keratoprosthesis and penetrating keratoplasty (TKP/PK). Methods: The charts of 15 patients undergoing combined PPV/TKP/PK for complex retinal detachment were reviewed in a retrospective manner to determine final anatomic and visual outcome as well as time to graft failure. Surgical techniques were analyzed for factors contributing to graft failure. Results:14/15 patients had a history of previous penetrating trauma in the operative eye, and 1/15 patients had history of aphakia after congenital cataract extraction. In the group of 14 eyes with previous trauma, there were 6 ruptured globes, 7 eyes with penetrating trauma, and 1 eye with blunt trauma at globe rupture. 6 eyes had evidence of perforating injury. 12/15 eyes had RD at the time of surgery, and 10 of these eyes had PVR. At the time of PPV/TKP/PK, silicone oil was used for tamponade in 10 eyes, C3F8 gas was used in 2 eyes, and SF6 was used in 1 eye. Mean follow-up after PPV/TKP/PK was16 months (mode: 9 months). Pre-operative vision was LP in 9/15 patients, and HM in 6/15 patients. Post-operative vision improved in 8 patients, was stable in 3 patients and worse in 4 patients; however, post-operative visual acuity was limited by other sequelae of ocular trauma and ranged from 2/200 E to NLP. At the time of last follow-up, 14/15 retinas were attached and 4/15 grafts were still clear. In the group of failed grafts (11/15), average time to graft failure was 6.7 months (range: 2.5 months to 16 months). At last follow-up, 1/15 eyes was phthisical, 3/15 eyes were felt to be pre-phthisical, and 4/15 eyes were hypotonous. The use of silicone oil vs. intraocular gas did not affect the survival time of the grafts. Of 10 eyes with silicone oil tamponade, only 2 eyes had silicone oil in contact with the graft: 1 of these eyes had a clear corneal graft at last follow-up, while the other eye had graft failure at 16 months. Conclusion: Combined PPV/TKP/PK surgery for complex retinal detachments can lead to a successful anatomic outcome, but visual outcomes are severely limited by other trauma-induced pathology.
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