Combined pars plana vitrectomy and tectonic keratoplasty - indications andoutcome in 15 patients

Background: Acute endophthalmitis requires a vitrectomy. Vitrectomy and aut okeratoplasty has been reported, if the infection originates from a stromal keratitis in an aphakic eye. This retrospective non-randomized cohort stud y points out the requirements, indications and results of combined keratopl asty and vitrectomy in keratitis and endophthalmitis compared with noninfec tious corneal and vitreoretinal problems. Patients and surgery: In 1995-1999, a vitrectomy and keratoplasty was perfo rmed on 15 patients (16 eyes), 10 of these with an endophthalmitis (median 71 years) and a follow-up of 2-60 months (median 19.3 months). 14 of 15 pat ients had had multiple prior surgery. Stromal keratitis as a sequela of ker atoplasty was seen in 5 eyes (3x ruptured suture), 5x diffuse infiltration in compromised corneas (Ix with a perforation, 2x with Fuchs' corneal dystr ophy, 3x postoperative). In the patients without endophthalmitis 6 eyes wer e aphakic with corneal scars and no fundus visualization. Five eyes had a r etinal detachment, one had an intraocular foreign body. An allogeneic kerat oplasty was done in 14, and an allogeneic sclerokeratoplasty and an autolog ous sclerokeratoplasty in one eye each. Results: Keratoplasty without keratoprosthesis allowed for fundus visualiza tion, and a pars plana vitrectomy was done with a wide angle contact lens, 8x with C2F6-, 1x with silicone oil 5000 cs instillation, and gentamicin an d 15 mug r-tPA added. In 5 vitrectomy specimens (50%) pathogenic bacteria w ere found. No recurrences of infection were seen. Conservation of the eyes and postoperative fundus visualization was possible in each case. The posto perative increase in visual acuity of 0.1 or better was significant in both patient groups. 2 eyes remained at preoperative levels, 14 ameliorated by >1 lines. Complications were Ix directly postoperative graft decompensation , Ix rejection after 40 months, 6x persisting secondary glaucomas, 2x hypot ony syndromes, 1x with phthisis and enucleation, 1x epiretinal gliosis. Conclusions: Curative surgery of acute keratitis and endophthalmitis by vit rectomy and keratoplasty may result in similarly successful outcomes as in noninfectious corneal scars and vitreoretinal pathology, if some requiremen ts (e.g. adequate antibiotic treatment, graft material, skilled anterior an d posterior segment surgeon) are fulfilled.