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. 2020 Sep 14;20(1):369.
doi: 10.1186/s12886-020-01639-y.

Pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series

Takahiko Hayashi  1   2   3   4   5 , Ida Yasutsugu  6   7 , Toshiki Shimizu  7 , Tsubasa Kuroki  6 , Yuji Kobashigawa  8 , Yasuhito Iijima  9 , Kentaro Yuda  7   10   11
Affiliations

Pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series

Takahiko Hayashi et al. BMC Ophthalmol. .

Abstract

Background: The aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes.

Methods: In this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to March 2018 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm2), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated.

Results: This study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 ± 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 ± 0.66 logMAR preoperatively to 0.78 ± 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 ± 238 cells/mm2 preoperatively to 1132 ± 323 cells/mm2 (p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 ± 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and spherical equivalent were 3.9 ± 3.2 D and 0.29 ± 2.18 D, respectively.

Conclusion: The combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma surgery.

Keywords: Intraocular lens implantation; Pars plana vitrectomy; Penetrating keratoplasty; Transscleral-sutured intraocular lens.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Design of combined penetrating keratoplasty (PKP), pars plana vitrectomy (PPV), and intraocular lens (IOL)-suture surgery a The surgical design should be determined prior to surgery including where to place the scleral ring and whether to create two scleral flaps or three-ports. After determination of the surgical design, two scleral pockets for the intraocular lens (IOL) suturing are created at the surgeons’ preference. b A scleral ring (Nishida ring, Inami) is sutured to the sclera with 6–0 silk. c Two 10–0 polypropylene sutures (PC-9) are fixated to the top of the IOL loop (CZ, Alcon) before the next procedure. d Three-ports are created using a 25-gauge trocar (Alcon), and the infusion canula was set. e Using the wide-viewing system, core vitrectomy and peripheral vitrectomy is performed. f, g Using a trephine and Katzin Scissors, the host cornea is removed. h In the open-sky technique (partial dissection), the IOL is sutured to the two scleral flaps 1.5 mm from the limbus. i The IOL is placed at the back of the iris and is centred. j The donor graft is sutured using 10–0 nylon
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