Combined corneal allotransplantation and vitreoretinal surgery using an Eckardt temporary keratoprosthesis: analysis for factors determining corneal allograft survival

Purpose To evaluate the outcome of corneal allotransplantation in combined penetrating keratoplasty and vitreoretinal surgery using a temporary keratoprosthesis, and to determine the factors affecting corneal allograft survival. Methods We reviewed the medical charts of eleven patients who had undergone combined corneal allotransplantation and pars plana vitrectomy using an Eckardt temporary keratoprosthesis, for the treatment of corneal opacification and vitreoretinal disease. The survival rates of the corneal grafts were assessed, and patient demographics, the diagnosis of corneal and retinal disease, the preoperative ocular characteristics, and surgical methods were compared between the group with graft survival and that with graft failure. Results The causes of corneal opacification were corneal laceration (four eyes), infectious keratitis (four eyes), atopic keratitis (one eye), rejected corneal graft (one eye), and uveitis-related bullous keratopathy (one eye). The preoperative diagnoses included endophthalmitis (six eyes), posterior uveitis (one eye), vitreous opacity or hemorrhage (two eyes), and rhegmatogenous retinal detachment (two eyes). The survival rate of the corneal allografts was 27.3% (3/11 eyes). The mean survival time was 391 days during the mean follow-up period of 687 days. The retinal surgery was successful in 81.8% (9/11 eyes) of cases. The presence of active inflammation in the cornea at the time of surgery was significantly correlated with graft rejection (P=0.004). Other factors, including age, the presence of glaucoma, type of corneal and retinal disease, or type of retinal surgery, such as silicone oil injection and gas tamponade, had no significant correlation with graft rejection. Conclusion Combined corneal allotransplantation and pars plana vitrectomy using a temporary keratoprosthesis allowed for successful surgical intervention in vitreoretinal disease. However, only 27.3% of corneal allografts survived, depending on the presence of active inflammation in the cornea.

[1]  M. Zarbin,et al.  Clinical Results with the Use of a Temporary Keratoprosthesis in Combined Penetrating Keratoplasty and Vitreoretinal Surgery , 2010, European journal of ophthalmology.

[2]  Jing Cui,et al.  Penetrating Keratoplasty Combined with Vitreoretinal Surgery for Severe Ocular Injury with Blood-Stained Cornea and No Light Perception , 2006, Ophthalmologica.

[3]  X. Dong,et al.  Long-term outcome of combined penetrating keratoplasty and vitreoretinal surgery using temporary keratoprosthesis , 2006, Eye.

[4]  K. Bartz-Schmidt,et al.  OUTCOME OF COMBINED PENETRATING KERATOPLASTY WITH VITREORETINAL SURGERY FOR MANAGEMENT OF SEVERE OCULAR INJURIES , 2003, Retina.

[5]  K. Bartz-Schmidt,et al.  Combined penetrating keratoplasty and vitreoretinal surgery with silicone oil: a 1-year follow-up , 2002, Graefe's Archive for Clinical and Experimental Ophthalmology.

[6]  T. Ikeda,et al.  Pars plana vitrectomy combined with penetrating keratoplasty , 2001, Seminars in ophthalmology.

[7]  J. Sugar,et al.  Outcome of vitreoretinal surgery and penetrating keratoplasty using temporary keratoprosthesis. , 1999, Retina.

[8]  R. Gallemore,et al.  Penetrating Keratoplasty with Vitreoretinal Surgery Using the Eckardt Temporary Keratoprosthesis: Modified Technique Allowing Use of Larger Corneal Grafts , 1995, Cornea.

[9]  B. McCuen,et al.  Results of penetrating keratoplasty associated with silicone oil retinal tamponade. , 1991, Ophthalmology.

[10]  W. Freeman,et al.  Combined penetrating keratoplasty and vitreoretinal surgery with the Eckardt temporary keratoprosthesis. , 1990, Ophthalmic surgery.

[11]  D. Fuller,et al.  Temporary keratoprosthesis for combined penetrating keratoplasty, pars plana vitrectomy, and repair of retinal detachment. , 1988, Ophthalmology.