Temporary Keratoprosthesis-Assisted Combined Pars Plana Vitrectomy-Penetrating Keratoplasty in High-Risk Eyes: Balancing Retinal Stability and Graft Survival.
TL;DR
Combined PPV-PK using TKP achieved retinal attachment in approximately 80% of eyes with complex anterior and posterior segment pathology, however, graft failure remained common and limited long-term visual rehabilitation.
Abstract
Purpose
The purpose of this study was to evaluate the clinical profile, complications, and anatomical and visual outcomes of high-risk eyes that underwent combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PK) using a temporary keratoprosthesis (TKP) in a single session.
Methods
We retrospectively reviewed all consecutive cases of combined PPV-PK performed at a tertiary center between June 2014 and December 2022. Demographics, indications, intraoperative details, postoperative complications, visual acuity (VA), and anatomical outcomes were recorded. Retinal attachment was assessed clinically when possible and by B-scan ultrasonography when corneal opacity precluded visualization.
Results
Forty-four eyes were included (mean age, 38.0 ± 27.1 years; 63.6% male). Mean follow-up was 23.1 ± 17.1 months. The commonest PK indications were traumatic corneal scar (31.8%), failed PK (25.0%), and corneal edema (18.2%). The most common PPV indications were retinal detachment (RD) without proliferative vitreoretinopathy (45.5%) and RD with proliferative vitreoretinopathy (22.7%). Intraoperative complications occurred in 8 eyes (18.2%) and were managed during the index surgery. At final follow-up, the retina remained attached in 35 eyes (79.6%), while corneal graft failure occurred in 25 eyes (56.8%). Eighteen eyes (40.9%) achieved counting-fingers vision or better, including 6 eyes (13.6%) with vision better than counting fingers. Among eyes with retinal attachment, 17 of 35 (48.6%) achieved counting-fingers vision or better. No statistically significant factor was associated with graft failure or final retinal attachment.
Conclusions
Combined PPV-PK using TKP achieved retinal attachment in approximately 80% of eyes with complex anterior and posterior segment pathology. However, graft failure remained common and limited long-term visual rehabilitation.