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A. Pielen, B. Junker, D. Böhringer, H. T. Agostini, T. Reinhard; Long-Term Outcome of Penetrating Keratoplasty Combined With Simultaneous Vitrectomy Without Temporary Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1162.
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To study the outcome of penetrating keratoplasty (PKP) and simultaneous pars plana vitrectomy (VE) without using temporary keratoprosthesis in patients with complex coexisting corneal and retinal disorders. Primary objective of combined surgery was to re-establish ocular anatomy and keep visual function even at a minimal level. Optimal surgical outcome was defined as corneal graft clarity, attachment of retina and controlled intraocular pressure (IOP).
Retrospective analysis. Medical records of 10 patients (4 female, 6 male, age 11 - 67 years, mean 51 years) who underwent PKP and simultaneous VE from 2005 until 2009 were reviewed. The mean follow-up was 24.5 months (range 0.5 - 55 months). We analysed corneal and retinal disorders leading to surgery, best corrected visual acuity (BCVA), corneal graft survival, attachment of retina and IOP.
There was a history of severe ocular trauma in 6 eyes, corneal graft failure in 4, retinal detachment in 7, endophthalmitis with perforating ulcera in 3, buphthalmus and phthisis in 2, respectively. BCVA pre-operatively was light perception (logMar 2.6) in 5 patients, hand motion (logMar 2.1) in 3, counting fingers (logMar 1.8) in 1, and logMar 1,2 in 1 patient (mean logMar 2.23). BCVA 1 week post-operatively was unchanged (mean logMar 2.31). BCVA at the end of follow-up improved (mean logMar 1.8, range logMar 0.7 - 2.6), 1 eye had to be enucleated. Regarding surgical outcome we saw corneal graft failure in 4 eyes, retinal detachment in 5 eyes of which 4 occurred within one month after combined surgery. Using Kaplan-Meier analysis median time until re-PKP was 25 months, till retinal detachment 9 months. Regarding IOP levels 3 patients received cyclodestructive surgery.
Combined PKP and simultaneous VE without keratoprosthesis is a highly demanding surgical method to handle eyes with complex coexisting corneal and retinal disorders. Ocular anatomy could be re-established in 9 out of 10 eyes, thus saved from enucleation. Retinal and corneal complications occured at a similar rate. One eye fulfilled all criteria of optimal surgical outcome. Due to the limited number of eyes none of the pre-existing ocular conditions could be identified as variable predicting graft failure or re-treatment rate.
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