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Randee C Miller, Yannek Isaac Leiderman; Indications and Outcomes of Combined Pars Plana Vitrectomy and Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2348.
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© ARVO (1962-2015); The Authors (2016-present)
To report the indications for and outcomes of combined pars plana vitrectomy and penetrating keratoplasty surgery.
A retrospective review of the medical records of all patients who underwent combined pars plana vitrectomy and corneal transplantation (PKP-PPV) at the Illinois Eye and Ear Infirmary from January 1, 2001 to May 31, 2013 was performed. Demographics, ocular history, surgical procedures performed, pre- and postoperative visual acuities, occurrence of surgical complications, and final anatomic outcomes were recorded for all patients.
Combined PKP-PPV was performed in ninety patients during the study period. Eleven patients were excluded because of insufficient data in the medical record. Of the remaining 79 patients (61% male, 39% female), 65 underwent a single combined PPV-PKP, 11 had two combined surgeries, and 3 required a third combined procedure. The mean age at first surgery was 48 years. The most common indications for vitreoretinal surgery were retinal detachment (43%) and proliferative vitreoretinopathy (30%). The most common indications for corneal transplantation were corneal decompensation (43%), traumatic corneal scar (20%), and failed corneal graft (19%). Forty-two patients (53%) had a history of ocular trauma; thirty-six (86%) of these eyes had a history of open globe injury. A temporary keratoprosthesis was utilized in 80% of combined surgeries. The mean preoperative visual acuity (VA) was LogMAR 2.4 (hand-motions). The mean final VA was LogMAR 2.3 (p=0.05) at a mean follow-up interval of 26 months. At final follow up 54% of retinas were attached and 56% of corneal grafts were clear. Eighty-two percent of patients had at least one postoperative complication, the most frequent being corneal graft failure (62%), recurrent retinal detachment (34%), and hypotony (31%). Thirty-one patients (40%) required at least one subsequent surgical procedure.
Patients requiring combined PPV-PKP were likely to maintain stable VA relative to preoperative VA for the indications in this study, most commonly retinal detachment and corneal decompensation associated with ocular trauma. Combined PPV-PKP may confer improved visual and anatomic outcomes relative to no intervention. Patients should be educated regarding likely outcomes and potential for subsequent surgical interventions.
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