Yu J, et al. Corneal graft outcomes after penetrating keratoplasty combined with temporary keratoprosthesis and vitreoretinal surgery. Presented at: American Academy of Ophthalmology meeting; Nov. 12-15, 2021; New Orleans.
Yu J, et al. Corneal graft outcomes after penetrating keratoplasty combined with temporary keratoprosthesis and vitreoretinal surgery. Presented at: American Academy of Ophthalmology meeting; Nov. 12-15, 2021; New Orleans.
NEW ORLEANS — A retrospective study in patients undergoing penetrating keratoplasty combined with temporary keratoprosthesis and vitreoretinal surgery identified silicone oil and history of trauma as risk factors for graft failure.
“Intraoperative use of [temporary keratoprosthesis] is a valuable tool that offers a clear view of the posterior segment in complex cases, in which corneal pathologies such as bullous keratopathy coexist with vitreoretinal diseases,” Julia Yu, BS, and Zeba A. Syed, MD, wrote in a poster presented at the American Academy of Ophthalmology meeting.
Data were gathered from a retrospective chart review of patients who received combined surgery at Wills Eye Hospital between 2007 and 2021. The goal was to analyze graft outcomes and identify risk factors associated with corneal graft failure, defined as irreversible graft edema or haze. Twenty-eight risk factors were considered, including history of trauma and inflammatory conditions, prior glaucoma and anterior segment surgery, concurrent lensectomy, with or without IOL implantation, and presence of postoperative silicone oil.
Results from 46 eyes of 46 patients were included. The most common indication for PK was secondary corneal edema in 52% of cases, followed by failed corneal transplant in 24%, corneal lacerations in 13% and corneal ulcers in 11%. The mean follow-up was 32 months. Overall, retinal attachment at the final follow-up visit was achieved in 91% of eyes.
“Only 37% had more than 3 years of follow-up,” Yu and Syed wrote. “Since many patients are referred to us for surgery from neighboring regions, subsequent visits are often performed by their local ophthalmologists.”
Following multivariable Cox proportional hazard analysis, two risk factors were found to be significantly associated with graft failure: history of trauma, specifically corneal lacerations, and postoperative silicone oil. Individually and combined, these two risk factors resulted in a highly significant reduction of graft survival.
“Our results may aid prognostication when considering combined surgery with [temporary keratoprosthesis],” Yu and Syed wrote.
The retrospective design was a limitation of the study, resulting in incomplete data regarding graft donor characteristics, severity of preoperative comorbidities and medication compliance. Another limitation was the small sample size; as a result, some risk factors may not have been identified due to insufficient statistical power.
“Future longitudinal studies with larger sample sizes may better represent these types of patients and further reveal risk factors,” the authors wrote.
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