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Impressum
One-Year Outcome of Penetrating Keratoplasty After Combined Vitreoretinal Surgery with Silicone Oil
1Roters S., 1Hamzei P., 2Szurman P., 2Bartz-Schmidt K. U., 1Kirchhof B.
1University of Cologne, Center of Ophthalmology, D-50924 Cologne, Germany; 2University of Tübingen, Dept. of Ophthalmology, D-72076 Tübingen, Germany
Purpose: A review of 53 eyes who underwent pars plana vitrectomy
with temporary keratoprosthesis, vitreoretinal surgery and penetrating
keratoplasty after intravitreal silicone oil tamponade.
Methods: Fifty-three eyes of 49 consecutive patients, operated
between 1991 and 1998, were retrospectively evaluated with a follow-up
of at least 12 months. Analysis was focused on ocular history, visual
acuity, intraocular pressure, anatomical anterior and posterior outcome
and complications.
Results: Thirty-four eyes with severe trauma had penetrating keratoplasty
in ten eyes (29%) during primary internal reconstruction and in 24 eyes
(71%) as a secondary procedure. Vitrectomy was performed due to retinal
detachment (9), uveitis (5), hypotony (4), endophalmitis (1) in 19 nontrauma
eyes suffering mainly from corneal decompensation. With a mean follow-up
of 28,4 months ± 18,8 months (range 12-84 months) an improvement
of visual acuity was seen in 58%. Only two eyes decreased in visual acuity,
one eye had to be enucleated because of painful phthisis. Reasons for
poor final VA were hypotony/phthisis (36%) in trauma and non-trauma eyes
and recurrent retinal detachment in 9% (mainly trauma eyes). Further surgery
was needed in 51%. Corneal grafts remained clear for one year in 68% with
a better survival rate for nontrauma eyes in 74% (trauma eyes in 65%).
Thirteen eyes received a second keratoplasty (25%). Two eyes had an immune
reaction (4%).
Conclusion: Outcome of combined surgery with penetrating keratoplasty
in eyes that would otherwise be untreatable is often complicated by secondary
graft failure. The risk of transplant failure is significantly smaller
in eyes that do not need a permanent silicone oil tamponade. In general,
posttraumatic eyes had a poorer outcome than eyes without trauma in history.
Long-time results are also limited by ciliary body malfunction. The preservation
of ambulatory vision is possible thus improving the quality of life at
least in patients with last eyes.