title: Penetrating keratoplasty surgery combined with vitrectomy after failing previous corneal surgery.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Juntendo University, Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, 279-0021, Japan. eyeofjun@mb.infoweb.ne.jp
authors.forename: Minoru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Masako
authors.initials: M
authors.lastname: Ando
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kitagawa
authors.forename: Izumi
authors.initials: I
authors.lastname: Shinohara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takebayashi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kiyokawa
authors.forename: Noriko
authors.initials: N
authors.lastname: Hatano
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sakuma
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Jun
authors.initials: J
authors.lastname: Shimazaki
mesh_terms: 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*