Penetrating keratoplasty surgery combined with vitrectomy after failing previous corneal surgery.
OBJECTIVE
The preoperative and postoperative factors influencing visual outcome were analyzed in 15 eyes of 15 patients with graft opacity after keratoplasty associated with vitreoretinal disease who underwent combined surgery of fresh corneal retransplantation and vitrectomy.


METHODS
The data obtained consisted of diagnosis, preoperative visual acuity, corneal and vitreoretinal findings at the time of surgery, interval between the first visit and surgery, intraocular pressure before surgery, gonioscopic findings, results of bacterial culture of surgical specimens, surgical procedure for vitrectomy, corneal and vitreous findings after surgery, visual acuity 6 months after surgery, intraocular pressure after surgery, and additional surgical techniques.


RESULTS
The cause of corneal opacity was graft rejection in all patients, who had been treated with high-dose administrations of steroids and cyclosporin. The preoperative diagnosis was proliferative vitreoretinopathy (PVR) in eight eyes and fungal endophthalmitis in seven eyes. Corneal transparency was achieved in 7 eyes (46.6%) 6 months after surgery. Vitreoretinal findings improved in 9 eyes (60%) and PVR recurred in 6 eyes (40%). Visual acuity improved in 7 eyes (46.6%), did not change in 2 eyes (13.3%), and deteriorated in 6 eyes (40%). The six eyes with decreased visual acuity developed phthisis bulbi. Preoperative intraocular pressure was 2.1 mmHg on average in the phthisis bulbi group, significantly lower than in the group with superior prognosis. Goniosynechia was noted before surgery and did not improve after surgery in all six eyes.


CONCLUSIONS
The outcome was poor in eyes with goniosynechia and ocular hypotony, and combined surgery is not indicated for either anatomic or visual preservation in such cases. Care should be taken not to overlook intraocular infection in patients undergoing immunosuppressive therapy against graft rejection. The early detection of retinal detachment is also important in eyes exhibiting hypotony after surgery.
Tanaka
Minoru
M
Department of Ophthalmology, Juntendo University, Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, 279-0021, Japan. eyeofjun@mb.infoweb.ne.jp
Ando
Masako
M
Kitagawa
Hitoshi
H
Shinohara
Izumi
I
Takebayashi
Hiroshi
H
Kiyokawa
Masatoshi
M
Hatano
Noriko
N
Sakuma
Toshiro
T
Kobayashi
Yasuhiko
Y
Shimazaki
Jun
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003318:Corneal Opacity / Q000209:etiology / Q000601:surgery*; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000150:complications; D005260:Female; D006084:Graft Rejection / Q000150:complications / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*; D018630:Vitreoretinopathy, Proliferative / Q000150:complications / Q000601:surgery*