Visual Outcomes After Temporary Keratoprosthesis Kristin C. Bains, MD Robert Phillips, MD The authors have no financial interest in the subject matter of this poster

1
Visual Outcomes After Temporary
KeratoprosthesisKristin C. Bains, MDRobert
Phillips, MDThe authors have no financial
interest in the subject matter of this poster
2
Purpose

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

3
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

4
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

5
Baseline Characteristics
Age (years) lt31 31-60 gt61 N20 N14 N13
Gender Male Female N31 N16
Eye OD OS N24 N23
Visual acuity Ambulatory HM LP NLP N11 N11 N25 N0
6
Baseline Characteristics (cont.)
Cornea status Scar Rejected graft BK N23 N19 N5
Retina status RD Attached Macular pucker Choroidal hemorrhage Vitritis Macular hole N29 N12 N3 N1 N1 N1
Comorbid ocular disease Secondary glaucoma Amblyopia Bells palsy Traumatic optic neuropathy Traumatic maculopathy N11 N3 N1 N2 N1
7
Baseline Characteristics
Traumatic injury Yes No N37 N10
8
Methods

• Wide-field Landers TKP
• Vitreoretinal procedures
• 3 port ppv
• Pars plana lensectomy if indicated
• Retinal reattachment
• Penetrating keratoplasty

9
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

10
Results
11
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

12
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