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Dae Seung Lee, Jang won Heo, Mee Kum Kim, Hyuk Jin Choi, Won Ryang Wee, Joo Youn Oh; Outcome of Combined Penetrating Keratoplasty and Vitreoretinal Surgery using Temporary Eckardt Keratoprosthesis and Analysis for Factors affecting Corneal Allograft Survival. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3073.
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To evaluate the outcome of combined penetrating keratoplasty and vitreoretinal surgery using temporary Eckardt keratoprosthesis and to analyze the factors affecting the corneal allograft survival.
We reviewed medical records of 11 patients who underwent combined corneal allotransplantation and pars plana vitrectomy using temporary Eckardt keratoprosthesis. Primary outcome measure was the survival rate of corneal grafts. Patient demographics, clinical features of the cornea and retina such as disease entities and preoperative status, or surgical methods were compared between the group with graft rejection and the group with graft survival.
The overall graft survival rate was 45.5 % (5/11 eyes). Retinal surgery was successful in 90.9 % (10/11 eyes). Rejection occurred in 5 patients (45.5 %, 5/11 eyes) with the mean survival time of 82.8 days during a follow up of 579 days. Four of 5 cases had the graft rejection within 2 months after surgery, and one patient had rejection at 7 months. The presence of inflammation or vascularization in the cornea before surgery was a significant factor affecting the occurrence of graft rejection (p value = 0.006). Active inflammation was present preoperatively in the recipient cornea in all patients with rejection. Corneal neovascularization was present in the recipient cornea in 4 of 5 patients with rejection. In contrast, there was no inflammation or vascularization in patients without rejection. The patient age, the presence of glaucoma, entities of corneal and retinal diseases, types of retinal surgery including the use of silicone oil or gas tamponade had no significant correlation with the graft survival or rejection.
Combined corneal allotransplantation and pars plana vitrectomy using temporary Eckardt keratoprosthesis allowed for successful surgical intervention of retinal diseases in patients with coexisting corneal opacity. Although the retinal outcome was excellent in 90.9 %, corneal allografts survived in 45.5%, largely depending on the preoperative status of the cornea including the presence of active inflammation or vascularization.
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