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A. Vaccaro, D. S. Chu, M. Zarbin; Keratoprosthesis Is a Bridge in Combined Penetrating Keratoplasty and Pars Plana Vitrectomy Surgeries. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5704. doi: https://doi.org/.
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Review of surgical outcomes using intraoperative keratoprostheses in patients undergoing combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PKP).
Retrospective chart review of patients undergoing combined PPV/PKP with intraoperative use of keratoprostheses to establish clear view of posterior segment for surgical intervention. We measured 4 variables: visual acuity defined as at least a change in 1 line, clarity of corneal graft, success of retinal reattachement and intraocular pressures.
We reviewed charts of 16 patients that have undergone combined PPV/PKP with intraoperative use of keratoprostheses. The age variation in population ranges from 16 months to 75 years old. The follow up period after combined surgical intervention is between 4 weeks to 4 1/2 years. The indications for surgery varied from ruptured globe 5 out of 16, ruptured globe with intraocular foreign body (1/16), retinopathy of prematurity (2/16), panuveitis (2/16), retinal detachement (4/16), and intervention secondary to complications of cataract surgery (2/16). Review of corneal graft clarity showed 12/16 had clear grafts, and 4/16 had graft failure. Review of anatomic success showed only 1/16 developed TRD (macula-on), and 15/16 had flat retina. Review of visual acuity divided patients into 4 groups based on visual acuity outcomes: 3/16 with post-operative improvement in vision, 6/16 had no change in vision consistent with stabilization of vision in a surgical eye, 3/16 experienced decrease in vision, and 4/16 had interval improvement in visual acuity with consequent reduction compaired to pre-operative vision. Review of IOP showed 2/16 patients have shown signs of phthisis secondary to hypotony pre-operatively with re-establishment of normal IOP.
This retrospective study demonstartes beneficial use of intraoperative keratoprostheses to allow for surgical retinal procedures in patients with corneal opacities that allow no or minimal view of posterior segment. In this study, 9/16 patients had either gained or at least maintained their visual acuity. The goal of surgical intervention was to prevent phthisis and enucleation.
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