Is a combined procedure of penetrating keratoplasty, vitreclomy, and selon implant in the pars plana effective?

Purpose: To assess the effectiveness of a combined procedure ( pars plana vitrectomy, penetrating keratoplasty, and pars plana insertion of a Seton implant) in preserving vision while controlling intraocular pressure, and maintaining graft clarity. Methods; We reviewed the course of visual acuity, intraocular pressure, graft clarity, and retina of 10 patients who underwent combined vitrectomy, penetrating keratoplasty, and insertion of a seton implant in the the pars plana. The vitrectomy consisted of complete removal of the vitreous base (by 360 degree depressed vitrectomy) and induction of a posterior vitreous detachment to facilitate tube placement in the pars plana. Vitrcctomies were performed with the aid of a temporary operating keratoprosthesis. Results; The preoperative diagnosis included pseudophakic bullous keratopathy and glaucoma (7 patients), congenital glaucoma (2 patients), and iridocomeal endothclial syndrome (1 patient). Preoperative mean visual acuity and intraocular pressure were hand motion and 25.4 mm Hg, respectively. The average follow up period was 12 months (3-18 months). Seven patients had improved vision, two patients had unchanged vision, and one patient had worse vision following surgery. The mean postoperative visual acuity and intraocular pressure were 20/800 and 13.4 mm Hg, respectively. Eight patients had postoperative visual acuity of 20/400 or better. The comeal grafts remained clear in nine patients during the follow up period. Also, nine patients did not have any retinal detachment The average number of glaucoma medications was 0.2. Complications included opacified graft in 1 patient, persistent hypotony and retinal detachment (1 patient), and a macula pucker (1 patient). Conclusion: Combined procedure (vitrectomy, penetrating keratoplasty, and pars plana insertion of a seton implant) offers effective control of intraocular pressure and preserves of corneal graft integrity. NONE.

Duke Scholars

Author Paul Pue-Jung Lee Ophthalmology, Glaucoma