title: Combined penetrating keratoplasty and vitreoretinal surgery with silicone oil: a 1-year follow-up.
abstract: BACKGROUND
  The aim of this study was to assess the functional outcome of eyes with corneal and vitreoretinal diseases following combined surgical procedures (pars plana vitrectomy with temporary keratoprosthesis, vitreoretinal surgery, and penetrating keratoplasty with intravitreal silicone oil tamponade) and to evaluate the factors preserving the clarity of grafts.
  
  
  METHODS
  Fifty-three eyes from 49 consecutive patients, operated on between 1991 and 1998 and followed up for at least 12 months, were evaluated retrospectively. The evaluation focused on ocular history, visual acuity (VA), intraocular pressure, anterior and posterior anatomical outcome, and complications.
  
  
  RESULTS
  The average follow-up was 28.4 months+/-18.8 months (range 12-84 months); at the final visit 58% of the eyes had better VA, and 73% had equal or better acuity; the cornea remained clear in 68% of the eyes. A decrease in VA was caused by: loss of light perception in 2 eyes, one of which had to be enucleated because of painful phthisis; hypotony or phthisis in 23 eyes; recurrent retinal detachment in 4 eyes that were operated because of trauma; and immunological reaction in 2 eyes. Preoperative factors that contributed to a clear graft, but were not significant, were: lack of trauma (74%), no actual silicone oil filling (78%), preoperative VA of hand movement or better (79%), and attached retina (73%). Further surgery was needed in 55% of cases. The risk of transplant failure was significantly lower in eyes that did not undergo additional surgery (p=0.0001).
  
  
  CONCLUSIONS
  The long-term results of combined surgery with penetrating keratoplasty in eyes that would otherwise be untreatable is often limited by anterior segment complications, mainly secondary graft failure and ciliary body malfunction. For optimal preservation of graft clarity, stable ocular status should be achieved before transplantation to minimize the necessity for further surgery.
authors.affiliation: Center of Ophthalmology, University of Cologne, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany, sigrid.roters@medizin.uni-koeln.de
authors.forename: Sigrid
authors.initials: S
authors.lastname: Roters
authors.forename: Peyvand
authors.initials: P
authors.lastname: Hamzei
authors.forename: Peter
authors.initials: P
authors.lastname: Szurman
authors.forename: Sigrid
authors.initials: S
authors.lastname: Hermes
authors.forename: Gabriele
authors.initials: G
authors.lastname: Thumann
authors.forename: Karl Ulrich
authors.initials: KU
authors.lastname: Bartz-Schmidt
authors.forename: Bernd
authors.initials: B
authors.lastname: Kirchhof
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003316:Corneal Diseases / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012163:Retinal Detachment / Q000150:complications / Q000601:surgery*; D012827:Silicone Oils / Q000627:therapeutic use*; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
chemical_list: D012827:Silicone Oils