Results of combined vitreoretinal intervention with penetrating keratoplasty in severe combat eye injury

Abstract

PURPOSE

To evaluate the results of combined pars planum vitrectomy (PPV) with the use of a temporary keratoprosthesis (TKP) in conjunction with primary penetrating keratoplasty or autokeratoplasty in cases of severe combat eye trauma.

SETTING / VENUE

SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine"

METHODS

Treatment results of combined vitreoretinal surgery employing a TKP and penetrating keratoplasty in 32 eyes of 31 patients with severe mine-explosive combat ocular trauma during 2022 and 2023 were retrospectively analyzed. Twenty patients (62.5%) had monocular involvement. The mean age was 35 years (range 21-54 years), with an average follow-up period of 8-9 months (range 1-20 months). Functional and anatomical treatment outcomes were evaluated, considering cases of transparent transplant grafting, improved visual functions, including the return of light perception (LP), normalized intraocular pressure (IOP), retinal re-attachment, and preservation of the eyeball as positive results. Intraoperatively, absence of the retina was diagnosed in 3 eyes (two patients), and in 3 eyes with intraocular foreign bodies, the retina was attached.

RESULTS

Preoperatively, visual acuity ranged from no LP in 8 eyes (25%) to fingers counting at 50 cm distance in 24 eyes (53.1%). At the conclusion of the observation period, no LP persisted in 3 eyes (9.37%), incorrect LP in 10 eyes (31.25%), correct LP in 4 eyes (12.5%), counting fingers at a distance of up to 50 cm in 7 eyes (21.8%), and in 2 eyes (6.25%), the best corrected visual acuity improved to 0.25 and 0.4 respectively. Postoperative IOP ranged between 10 and 25 mmHg, with hypotensive drops prescribed for 5 eyes to normalize pressure. Retinal re-attachment was achieved in 24 eyes (75%), with 2-3 vitreoretinal interventions required for complete attachment in 7 cases and non-adherence in 2 eyes. Postoperatively, the corneal graft remained transparent in 13 eyes (40.62%), partially cloudy in the periphery in 9 eyes (28.1%), and intense graft opacification and vascularization were observed in 10 eyes (31.2%). Notably, in 3 patients with monocular involvement and no LP, phthisis bulbi from 16.5 to 18 mm, LP was restored, and further atrophy progression was prevented. Conversely, pronounced atrophy with eyeball deformation developed in 5 eyes of 4 patients. Prophylactic enucleation was performed in 1 case.

CONCLUSIONS

Combined pars planum vitrectomy with a temporary keratoprosthesis and penetrating keratoplasty allows not only preserve eyes and residual vision, but improve visual acuity after severe mine explosive ocular trauma. In certain cases, this procedure represents the last chance for a possible return of light perception in monocular patients. Factors influencing the final functional and anatomical result include the preoperative condition of the cornea, which may preclude transparent grafting, severe damage to the retina and optic nerve, as well as the development of proliferative vitreoretinopathy in the postoperative period, leading to recurrence of retinal detachment and phthisis bulbi of the eyeball.