Outcomes of combined keratoplasty and pars plana vitrectomy for endophthalmitis with compromised corneal clarity.

Abstract

Studies evaluating combined penetrating keratoplasty and pars plana vitrectomy for infectious aetiologies are limited. To evaluate the outcomes of combined penetrating keratoplasty and pars plana vitrectomy in patients with endophthalmitis and poor corneal clarity. Retrospective interventional case series conducted at a tertiary care eye hospital in North India. Review of records of 43 eyes of 43 patients. Mean age of patients was 53.39 ± 12.94 years (26 males). Patients with age > 14 years with minimum follow-up of 6 months were included. Combined penetrating keratoplasty and pars plana vitrectomy was performed in all eyes. We analysed the preoperative, intraoperative and microbiological characteristics of patients undergoing combined surgeries. Anatomic and functional success and failure were pre-defined. Aetiology for corneal opacification was corneal ulcer in 30(69.7%) eyes, corneal graft infection in eight(18.6%) eyes, bullous keratopathy in four (9.3%) eyes and corneal scar in one eye. Postoperative visual acuity improved in 20(46.5%) eyes, did not change in 14 (32.5%) eyes and deteriorated in nine eyes (20.9%). Anatomical failure (uncontrolled infection leading to phthisis bulbi or evisceration) was seen in 15 (34.8%) eyes. Microbiological analysis revealed bacterial growth in 26, fungal in 14 and no growth in three eyes. Fungal infection had a poorer outcome (P = 0.03). Six out of 11 monoocular patients regained ambulatory vision. Combined penetrating keratoplasty and pars plana vitrectomy is a complex but globe salvaging procedure for poor prognosis eyes which otherwise may need evisceration. Fungal infection carries a poorer prognosis.