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S Roters, P Hamzei, P Szurman, G Thumann, KU Bartz-Schmidt, B Kirchhof; One-Year Outcome of Penetrating Keratoplasty After Combined Vitreoretinal Surgery with Silicone Oil . Invest. Ophthalmol. Vis. Sci. 2002;43(13):638.
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Purpose: To assess the natural course of eyes with corneal and vitreoretinal diseases after combined procedure (pars plana vitrectomy with temporary keratoprosthesis, vitreoretinal surgery and penetrating keratoplasty) with intravitreal silicone oil tamponade. Methods: Fifty-three eyes of 49 consecutive patients, operated between 1991 and 1998, were retrospectively evaluated with a follow-up of at least 12 months. Analysis was focused on ocular history, visual acuity, intraocular pressure, anatomical anterior and posterior outcome and complications. Results: With a mean follow-up of 28,4 months ± 18,8 months (range 12-84 months) an improvement of visual acuity was seen in 58%, and 73% maintained equal or better at their final visit. Two eyes finally lost light perception, one of them had to be enucleated because of painful phthisis. Reasons for poor final VA were hypotony/phthisis (43%). Recurrent retinal detachment was seen mainly in trauma eyes (9%). Corneal grafts remained clear for one year in 68%.The following factors showed a better - but not significant - survival rate: non-trauma eyes (74%), no actual silicone oil filling (78%), preoperative visual acuity of hand movement or better (79%) and attached retinal situation (73%). Two eyes had an immune reaction (4%). Thirteen eyes received a second keratoplasty (25%). Further surgery was needed in 55%. The risk of transplant failure was significantly lower in eyes that did not undergo further surgery (p=0.0001). Conclusion: Combined surgery with penetrating keratoplasty in eyes that would otherwise be untreatable is often complicated by secondary graft failure. Even though the long-time results are also limited by ciliary body malfunction, a stable ocular situation meet the requirement for final surgical intervention and therefore preserving grafts clarity.
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