Combined Penetrating Keratoplasty and Vitreoretinal Surgery With Temporary Keratoprosthesis

Abstract

Purpose: The aim of this study was to evaluate outcomes of vitreoretinal surgery with temporary keratoprosthesis combined with penetrating keratoplasty. Setting: The study was conducted at a university-based corneal and retinal disease referral practice, Ann Arbor, MI. Methods: This study is a retrospective analysis of 43 patients who underwent vitreoretinal surgery with a temporary keratoprosthesis combined with penetrating keratoplasty. Functional (best-corrected visual acuity and corneal transplant survival rate) and anatomical (clear corneal graft and retinal attachment) outcomes were measured. Results: Both corneal transplant and retinal attachment outcomes were evaluated. There was no difference in visual acuity, retinal attachment rates, or corneal transplant survival rates when comparing adult age, sex, and graft size. Pediatric eyes, however, were more likely to have a poor corneal transplant outcome. After an initial combined procedure with a temporary keratoprosthesis, 15 of 43 corneas (35%) remained clear and 23 (53%) retinas remained attached. With additional surgery, 19 of the corneas (44%) and 32 of the retinas (74%) had satisfactory outcomes. Best-corrected visual acuity (BCVA) initially improved in 23 patients (53%), with lasting improvement at final follow-up in 12 patients (28%). Twenty-five patients (58%) obtained equal or improved vision at last follow-up as compared to the presenting vision. The primary causes of poor visual acuity outcome were phthisis (49%) and retinal detachment (26%). Corneal decompensation and hypotony were often associated with phthisis and, therefore, resulted in a poor visual outcome. Trauma (53%) also resulted in an increased rate of phthisis. However, those eyes sustaining trauma, which did not become phthisical, had better visual outcomes. Silicone oil usage improved retinal reattachment rates and had no deleterious effects on corneal transplant survival. Conclusions: The combined procedures of vitreoretinal surgery with temporary keratoprosthesis and penetrating keratoplasty can salvage severely damaged eyes and provide functional vision in some patients. Factors predicting worse final visual outcome include preoperative total retinal detachment, severe chronic retinal pathology in the absence of trauma, and postoperative phthisis or retinal detachment.