A novel temporary keratoprosthesis technique for vitreoretinal surgery

AIM: To investigate the safety of vitreoretinal surgery when using a soft contact lens as a temporary keratoprosthesis (TKP) in patients with severe corneal opacifications. METHODS: Three patients with simultaneous corneal and vitreoretinal pathology were treated with a soft contact lens that was used as a TKP to facilitate vitreoretinal surgery. The soft contact lens was fixated with sutures onto the globe so that no leakage was possible. RESULTS: Vitreoretinal surgery with excellent fundus view was possible in all cases. The soft contact lens allowed safe central and peripheral vitrectomy. Surgery was successful in all cases. CONCLUSION: A soft contact lens properly fixated on the globe can successfully replace a TKP. This surgical procedure has several advantages like one size fits all, low costs, and easy access to the material.

Simultaneous Vitreoretinal Surgery and Penetrating Keratoplasty without a Keratoprosthesis or Endoscopy for Vitreoretinal Disease Associated with Corneal Opacity

We evaluated the visual outcome of combined penetrating keratoplasty (PKP) and 25G pars plana vitrectomy (PPV) performed without a temporary keratoprosthesis or endoscopy in a patient with vitreoretinal disease complicated by severe corneal opacity. The patient was a 68-year-old woman who had severe corneal opacity and silicone oil in her left eye after several previous intraocular surgeries for rhegmatogenous retinal detachment and proliferative vitreoretinopathy. We successfully performed a combined surgery of conventional PKP followed by 25G PPV without the use of a keratoprosthesis.At 6 months after surgery, visual acuity had not improved, and the density of corneal endothelial cells of the donor cornea had declined from 3,205 to 1,969 cells/mm2. However, corneal transparency remained good, and additional surgery for vitreoretinal disease was not necessary. The combined surgical procedure designed to minimize the number of open-sky steps and to limit vitreoretinal complications thus proved to be safe and achieved stable corneal clarity in a patient with vitreoretinal disease and severe corneal opacity.

Comparison of endoscopic-assisted and temporary keratoprosthesis-assisted vitrectomy in combat ocular trauma: experience at a tertiary eye center in Turkey

Objective This study was performed to compare the functional and anatomical results of endoscopic-assisted and temporary keratoprosthesis (TKP)-assisted vitrectomy in patients with combat ocular trauma (COT). Methods The medical records of 14 severely injured eyes of 12 patients who underwent endoscopy or TKP implantation in combination with vitreoretinal surgery from 2007 to 2015 were retrospectively evaluated. The patients’ ocular history and functional and anatomic anterior and posterior segment results were analyzed. Results Eight eyes (57%) underwent TKP-assisted vitrectomy and six eyes (43%) underwent endoscopic vitrectomy. The most common cause of COT was detonation of improvised explosive devices (72%), and the most common type of injury was an intraocular foreign body (50%). The median time from trauma to surgery and the median surgical time were significantly shorter in the endoscopy than TKP group. The postoperative functional and anatomical results were not significantly different between the two groups. Conclusions TKP-assisted vitrectomy should be performed in eyes requiring extensive bimanual surgery. In such cases, a corneal graft must be preserved for the TKP at the end of the surgery. Endoscopy shortens the surgical time and can reduce the complication rate.