Combined penetrating keratoplasty and vitreoretinal surgery using temporary Landers keratoprosthesis

Dr.Rama Rajagopal, Dr. Bhaskar Srinivasan, Dr.Nidhi Gupta, Dr.Pramod.S.Bhende, Dr.Prema Padmanabhan

PURPOSE : To assess the feasibility and outcome measures of combined penetrating keratoplasty and vitreoretinal surgery using temporary keratoprosthesis.

METHODS : Between January 2005 and March 2010, 30 out of 45 patients underwent combined penetrating keratoplasty with vitreoretinal surgery using Landers-Foulks keratoprosthesis. Patients with minimum followup of 3months were included in the study. Indications for surgery, visual acuity, graft clarity, intraocular pressure and retinal status at last follow up were evaluated.

RESULTS: 20 eyes had penetrating injury with associated retinal detachment (17 eyes) or intraocular foreign body (3 eyes). Seven eyes had retinal detachment with corneal scarring, 2 had corneal decompensation with retinal detachment and 1 eye had corneal blood staining with retinal detachment. Landers keratoprosthesis enabled excellent intraoperative visualization during vitreoretinal surgery to complete all necessary steps. At mean follow up of 9.38 months (3-36 months), 14 eyes had attached retina and graft remained clear in 7 eyes. Two eyes underwent regrafting and in one eye Boston keratoprosthesis was done following multiple graft failure. Twelve eyes became phthisical. Visual acuity improved in 5 eyes and remained the same in 13 eyes. The causes of poor visual acuity were phthisis, graft failure, retinal redetachment, glaucoma, macular scarring and amblyopia.

CONCLUSION : Combined penetrating keratoplasty with vitreoretinal surgery using Landers keratoprosthesis enables to salvage a few of these eyes which otherwise would have been inoperable. Final outcome depends on underlying graft clarity, posterior segment pathology and ciliary body status.