Vitreoretinal management in osteo‐odonto‐keratoprosthesis surgery

Abstract

Abstract Purpose: To review the strategies, problems and technical issues in dealing with vitreo‐retinal pathology in eyes before, during and after osteo‐odonto keratoprosthesis (OOKP) surgery. Methods: A retrospective review of eight consecutive cases in which vitreo‐retinal intervention was required in the OOKP programme in the Singapore National Eye Centre. Results: Six eyes had retinal detachments. Three of these had limited previously untreated retinal detachments with traction, detected on b‐scan ultrasonography. Repair of the retinal detachments preceded completion of the OOKP procedures although one eye required a repeat vitrectomy for a recurrent detachment with the prosthesis in place. One eye had a massive choroidal haemorrhage resulting in abortion of OOKP stage two surgery. The choroidal haemorrhage resolved, leaving a localized traction‐associated retinal detachment that was repaired during repeat stage two surgery. Two eyes had prior retinal surgery for presumed detachments with silicone oil in place prior to OOKP surgery. Stage two surgery was completed with assessment and confirmation of stability of retinal pathology.Two eyes required vitreo‐retinal intervention for endophthalmitis. One developed infection after stage two surgery and was successfully salvaged. The other developed endophthalmitis after endoscopic cyclophotocoagulation for glaucoma 18 months after stage two surgery. This eye was lost in spite of aggressive intervention.The use of temporary keratoprostheses and vitrectomy endoscopes during surgery was necessary in most of these eyes. Conclusions: OOKP surgery presents challenges for the vitreo‐retinal colleague. Assessment of the anatomical and functional integrity of the retina prior to and often after OOKP surgery is hampered. An accurately interpreted b‐scan ultrasound examination provides the most useful information. Vitreo‐retinal surgical intervention is technically demanding and requires the use of temporary keratoprostheses and endoscopes. An individualized and realistic management strategy has to be derived for patients with vitreo‐retinal pathology when OOKP surgery is embarked upon.