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Temporary keratoprosthesis combined vitreoretinal surgery and keratoplasty: visual and surgical outcomes

Florence Cabot1*, D Wade Redick1, Nathan Pirakitikulr1, Ann V Quan1, Francesco Pozzo Giuffrida1, Diana Laura1, Nicolas A Yannuzzi1, Harry W Flynn1, Nimesh A Patel2

Background: Examine visual and surgical outcomes in combined Pars Plana Vitrectomy and Penetrating Keratoplasty using Temporary Keratoprosthesis (TKpro/PPV/PKP). Methods: Retrospective case series. All cases of TKpro/PPV/PKP performed at the Bascom Palmer eye institute in Miami, FL, from 2013 to 2020 were reviewed. The study included 55 eyes (55 patients). Results: Median follow-up was 18.4 months. Preoperative Visual Acuity (VA) ranged from Light Perception (LP) to 20/200. VA at last exam was ≥ 20/200 in 14 eyes (25%). VA of No Light Perception (NLP) occurred in 5 eyes postoperatively (9.1%). Enucleation was performed in 1 eye (1.8%) postoperatively. Corneal graft remained clear at last exam in 32 eyes (58%). There was no significant difference in percentage of eyes with VA ≥ 5/200 at last exam and rates of improvement in VA between eyes with infection and without infection (p=0.48; p=0.32). Infectious cases were less likely to have a clear graft at last exam (p=0.0019). There was no significant difference in rates of improvement in VA from preoperative between traumatic and non-traumatic cases (p=0.18). Preoperative VA of LP was associated with increased risk of NLP, enucleation or phthisis bulbi at last exam (p=0.0219). Conclusion: In the current study, infectious and non-infectious cases had similar visual outcomes although infectious cases were less likely to have a clear graft at last exam than non-infectious cases. Visual outcomes were similar between traumatic and non-traumatic cases. Preoperative VA of LP was a poor prognostic sign for visual outcomes.