title: Combined corneal allotransplantation and vitreoretinal surgery using an Eckardt temporary keratoprosthesis: analysis for factors determining corneal allograft survival.
abstract: OBJECTIVE
  To evaluate the outcome of corneal allotransplantation in combined penetrating keratoplasty and vitreoretinal surgery using a temporary keratoprosthesis, and to determine the factors affecting corneal allograft survival.
  
  
  METHODS
  We reviewed the medical charts of eleven patients who had undergone combined corneal allotransplantation and pars plana vitrectomy using an Eckardt temporary keratoprosthesis, for the treatment of corneal opacification and vitreoretinal disease. The survival rates of the corneal grafts were assessed, and patient demographics, the diagnosis of corneal and retinal disease, the preoperative ocular characteristics, and surgical methods were compared between the group with graft survival and that with graft failure.
  
  
  RESULTS
  The causes of corneal opacification were corneal laceration (four eyes), infectious keratitis (four eyes), atopic keratitis (one eye), rejected corneal graft (one eye), and uveitis-related bullous keratopathy (one eye). The preoperative diagnoses included endophthalmitis (six eyes), posterior uveitis (one eye), vitreous opacity or hemorrhage (two eyes), and rhegmatogenous retinal detachment (two eyes). The survival rate of the corneal allografts was 27.3% (3/11 eyes). The mean survival time was 391 days during the mean follow-up period of 687 days. The retinal surgery was successful in 81.8% (9/11 eyes) of cases. The presence of active inflammation in the cornea at the time of surgery was significantly correlated with graft rejection (P=0.004). Other factors, including age, the presence of glaucoma, type of corneal and retinal disease, or type of retinal surgery, such as silicone oil injection and gas tamponade, had no significant correlation with graft rejection.
  
  
  CONCLUSIONS
  Combined corneal allotransplantation and pars plana vitrectomy using a temporary keratoprosthesis allowed for successful surgical intervention in vitreoretinal disease. However, only 27.3% of corneal allografts survived, depending on the presence of active inflammation in the cornea.
authors.affiliation: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Dae Seung
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jang Won
authors.initials: JW
authors.lastname: Heo
authors.affiliation: Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Mee Kum
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Won Ryang
authors.initials: WR
authors.lastname: Wee
authors.affiliation: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Joo Youn
authors.initials: JY
authors.lastname: Oh
keywords: corneal transplantation; inflammation; vitrectomy