Visual Outcomes After Temporary Keratoprosthesis

Kristin C. Bains, MDRobert Phillips, MD

The authors have no financial interest in the subject matter of this poster

Purpose

• To evaluate visual outcomes after combined penetrating keratoplasty (PK) and vitreoretinal surgery using temporary keratoprosthesis (TKP)

Introduction • Utilized in patients with coexisting corneal and

vitreoretinal pathology• Combined procedure necessary for adequate

visualization intraoperatively• If combined only with PK, delay waiting for graft to

clear, leading to worsening retinal pathology• Does not expose patient to risks associated with

open-sky vitrectomy• Attempts to restore visual function by allowing

earlier surgical intervention

Methods

• IRB approval obtained• Retrospective, observational case series

– CPT code 65770 – Date range: 2003-2010– 55 eyes of 47 patients identified

• 1 corneal surgeon, multiple vitreoretinal surgeons• Included: 47 eyes of 41 patients who underwent

combined TKP/PK and vitreoretinal surgery• Excluded: 8 eyes of 6 patients lost to follow-up• Previous surgeries common

Baseline Characteristics

Age (years) <31

31-60

>61

N=20

N=14

N=13

Gender Male

Female

N=31

N=16

Eye OD

OS

N=24

N=23

Visual acuity Ambulatory

HM

LP

NLP

N=11

N=11

N=25

N=0

Baseline Characteristics (cont.)

Cornea status Scar

Rejected graft

BK

N=23

N=19

N=5

Retina status RD

Attached

Macular pucker

Choroidal hemorrhage

Vitritis

Macular hole

N=29

N=12

N=3

N=1

N=1

N=1

Comorbid ocular disease Secondary glaucoma Amblyopia

Bells’ palsy

Traumatic optic neuropathy

Traumatic maculopathy

N=11

N=3

N=1

N=2

N=1

Baseline Characteristics

Reasons for TKP/PK

Atraumatic

Traumatic

Traumatic injury

Yes

No

N=37

N=10

Methods

• Wide-field Landers TKP

• Vitreoretinal procedures– 3 port ppv– Pars plana lensectomy if

indicated– Retinal reattachment

• Penetrating keratoplasty

Results

• Follow-up: 1 month- 67 months• Mean pt follow-up: 23.4 months

• Post-operative graft status at final follow-up

• 17 clear (36.9%)

• 29 rejected

• 7 repeat TKP/PK

• 5 repeat PK

Results

Pre- and Post-TKP/PK Visual Acuities

0

5

10

15

20

25

30

Num

ber

of P

atien

ts

Pre-op 11 11 25 0

Post Op 16 17 6 8

Ambulatory Hand Motion Light Perception NLP

Conclusions

• Before combined surgery 21 eyes had BCVA of ambulatory to HM.

• Post-operatively, majority of patients (32 eyes) had BCVA of ambulatory to HM.

• 93.6% of eyes (44 eyes) were retained

• 2.1% of eyes (1 eye) became phthisical

Conclusion

• Tool used in management of complex disease, without which, many eyes could not be salvaged

• Combined surgery is not without complications

• Outcomes can be good considering complexity of pathology