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Comparative study of penetrating keratoplasty and vitreoretinal surgery with Eckardt temporary keratoprosthesis in ocular trauma versus non-trauma patients

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Abstract

Purpose

To evaluate the effectiveness of temporary keratoprosthesis combined with vitreoretinal surgery and penetrating keratoplasty in patients with or without trauma.

Methods

This retrospective study included 49 eyes in 49 non-trauma patients and 51 eyes in 48 ocular trauma patients who underwent penetrating keratoplasty and vitreoretinal surgery with Eckardt temporary keratoprosthesis between 2009 and 2016, with a follow-up of at least 12 months. Study variables included previous corneal, glaucoma, or retinal surgeries; various intraoperative surgical maneuvers; lens status; vitreoretinal and corneal pathology; functional outcomes; anatomical retinal reattachment; graft clarity; and need for glaucoma surgery or treatment.

Results

The mean age was 56 years in the non-trauma group and 42 years in the ocular trauma group. A total of 45% of the non-trauma cases and 24% of the ocular trauma cases had a single functional eye. Pseudophakic and aphakic keratopathy was diagnosed in 41% of the non-trauma group and corneal laceration in 65% of the ocular trauma group. In the ocular trauma group, injuries were open globe injury in 78%, closed globe injury in 12%, and intraocular foreign body in 10%. Retinal detachment with proliferative vitreoretinopathy was present in 39% of patients in the non-trauma group and in 35% of the ocular trauma group. Improvement or stability of visual acuity was higher among ocular trauma patients (86%) than in non-trauma patients (78%). The rate of clear corneal grafts was 49% in both groups. Retinal attachment was achieved in 90% and 78% of patients in the non-trauma and ocular trauma groups, respectively. The use of retinotomy had a positive influence on the final attached retina (p = 0.016). The placement of a scleral buckle significantly increased the risk of glaucoma (p = 0.004). Poor functional outcome was related to persistent retinal detachment (10% versus 16% in the non-trauma and ocular trauma groups, respectively), phthisis (25% versus 12%), hypotony (33% versus 18%), corneal graft end failure (51% in both groups), and secondary glaucoma (18% versus 24%).

Conclusion

In patients with both vitreoretinal and corneal pathology, the use of Eckardt temporary keratoprosthesis combined with vitreoretinal surgery and penetrating keratoplasty resulted in improvement of visual acuity, particularly in the groups of ocular trauma and monocular patients. The high rate of retinal reattachment and the low rate of graft rejection was probably related to the use of new vitreoretinal techniques, including retinotomy in selected patients.

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Acknowledgments

The authors thank Marta Pulido, MD, for editing the manuscript and for her editorial assistance.

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Authors and Affiliations

  1. Instituto de Microcirugía Ocular (IMO), C/ Josep María Lladó 3, 08035, Barcelona, Spain

    Maria Bové Álvarez, José Luis Güell, Óscar Gris, Carlos Mateo, Borja Corcóstegui & José García-Arumí

  2. Department of Ophthalmology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Claudia García Arumí, Laura Distéfano & José García-Arumí

Authors
  1. Maria Bové Álvarez
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  2. Claudia García Arumí
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  3. Laura Distéfano
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  4. José Luis Güell
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  5. Óscar Gris
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  6. Carlos Mateo
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  7. Borja Corcóstegui
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  8. José García-Arumí
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Corresponding author

Correspondence to Maria Bové Álvarez.

Ethics declarations

The study was approved by the Ethics Committee of IMO medical center and adhered to the tenets of the Declaration of Helsinki.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bové Álvarez, M., Arumí, C.G., Distéfano, L. et al. Comparative study of penetrating keratoplasty and vitreoretinal surgery with Eckardt temporary keratoprosthesis in ocular trauma versus non-trauma patients. Graefes Arch Clin Exp Ophthalmol 257, 2547–2558 (2019). https://doi.org/10.1007/s00417-019-04420-0

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  • DOI: https://doi.org/10.1007/s00417-019-04420-0

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