RESULTS OF RETINAL DETACHMENT SURGERY IN EYES WITH OSTEO-KERATOPROSTHESIS

Retinal Detachment in Eyes with Boston Type 1 Keratoprosthesis: Surgical Techniques and Mid-Term Outcomes

PURPOSE

To evaluate the mid-term outcomes of pars plana vitrectomy (PPV) performed for retinal detachment (RD) repair after Boston type 1 keratoprosthesis (KPro) implantation.

METHODS

Retrospective chart review of KPro implanted at the Stein Eye Institute presenting with RD and treated by PPV. Functional success was defined as a postoperative visual acuity (VA) maintained within 2 Snellen lines of the CDVA measured before the development of the RD (baseline) and anatomical success as an attached retina after the PPV. Kaplan-Meyer survival analyses were performed.

RESULTS

Among the 224 KPro performed, 28 (15.2%) RD were identified, of which 21 (9.4%) were included. The mean follow-up was 42.5 ± 27.3 months. Vitreoretinal proliferation was present in 18/21 (85.7%) eyes. Surgical techniques were adapted to the complex anterior segment anatomy of KPro eyes. Anatomical success was achieved in 18/21 (85.7%) eyes. Functional success occurred in 17/21 (81.0%) eyes, and 5/21 (23.8%) eyes reached 20/400 or better VA at final follow-up. The KPro was retained in 11/21 (52.4%) eyes. The retention rate decreased from 94.7% at 1 year to 53.5% at 5 years. The most frequent complications were retroprosthetic membrane (47.6%) and corneal melt (23.8%).

CONCLUSION

Modified PPV techniques resulted in relatively good mid-term anatomic, functional, and retention rate outcomes, given the severity of RD at presentation, and the numerous preoperative comorbidities of KPro eyes.

VITRECTOMY FOR ENDOPHTHALMITIS IN EYES WITH OSTEOKERATOPROSTHESIS

PURPOSE

To analyze functional and anatomical results of pars plana vitrectomy (PPV) to treat endophthalmitis in eyes with osteokeratoprosthesis.

METHODS

An observational, retrospective study of five eyes suffering from endophthalmitis, after an osteokeratoprosthesis implantation, which underwent PPV associated with intravitreal antibiotics. The minimum follow-up after PPV was 6 months. A descriptive study and a Kaplan-Meier survival analysis for anatomical (attached retina during the follow-up) and functional success (visual acuity ≥20/400) were performed.

RESULTS

Best-corrected visual acuity during the final follow-up was 20/100 in 1 case (20%), hand movement in another case (20%), and no light perception in 3 cases (60%). The anatomical survival rates were recorded at 80%, 60%, and 40% at 1, 6, and 8 months respectively, and this last value was maintained at 12 months after PPV. The functional survival rates were recorded at 40% and 20% at 1 month and 8 months, respectively, and this last value was maintained at 12 months after PPV.

CONCLUSION

Endophthalmitis in eyes with previous osteokeratoprosthesis is a very severe complication with a reserved prognosis. Pars plana vitrectomy associated with intravitreal antibiotics leads to maintaining or increasing visual acuity in a small proportion of patients who otherwise would end up blind.