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Y. Tu, A. Khouri, M. Zarbin, D. Chu; Clinical Results With the Use of a Temporary Keratoprosthesis in Combined Penetrating Keratoplasty and Vitreoretinal Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1155.
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To evaluate the surgical outcomes using a temporary intraoperative keratoprosthesis (KP) in patients undergoing combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PKP).
From January 2001 to August 2008, 24 eyes of 23 patients needing combined KP/PPV/PKP surgical intervention for traumatic and nontraumatic corneal and retinal pathologies were studied. A KP was needed to establish a clear view of the posterior segment during surgical intervention. Multiple parameters including patient baseline characteristics, previous ocular procedures, visual acuity, intraocular pressure, and status of the retina and cornea at baseline, and postoperatively on day-1, months-1 and -6, and yearly until the last follow-up. Anatomical success was defined as retinal reattachment intraoperatively to the end of the follow-up period, and corneal graft clarity from 4 weeks postoperatively to the end of the follow-up period. The functional outcome was defined as a change in best corrected visual acuity of more than 2 Snellen lines, or among categories of finger counting ability, hand movement and light perception. Visual acuity change was classified as: improved, stable, or decreased.
23 patients underwent the combined KP/PPV/PKP. Mean follow-up was 36 months (range 6-162 months). Seventeen (74%) of 23 subjects had follow-up more than 12 months. Functional outcomes: No eyes had visual acuity better than 20/400 pre-operatively. At final follow-up, best corrected visual acuity improved in 40% of eyes, remained stable in 40%, and worsened in 20%. Anatomical outcomes: Corneal graft was clear in 18 (75%) of eyes, 5 (21%) had graft failure, and 1 (4%) developed transient graft edema that resolved. Retinal reattachment occurred in 22 (92%) eyes; 2 (8%) developed a localized traction retinal detachment that did not warrant additional surgery. Silicone oil use was necessary in 21 (88%) of 24 eyes. Derangement in intraocular pressure (IOP) was common (13 (54%) eyes). Elevated IOP (>21 mmHg) necessitating treatment occurred in 5 (21%), and hypotony (<6 mmHg) occurred in 8 (33%). Three eyes (13%) showed signs of phthisis secondary to persistent hypotony pre-operatively that resolved with re-establishment of normal IOP postoperatively.
In this study temporary KP during PPV/PKP surgery allowed surgical intervention in eyes with complex anterior and posterior segment disease. Corneal graft clarity and successful retinal reattachment was possible in the majority of eyes.
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