PENETRATING KERATOPLASTY IN APHAKIC EYES, WITH AND WITHOUT COMBINED VITREORETINAL SURGERY: THE CHALLENGE OF SUTURE PLACEMENT

To present the differences in two cases of penetrating keratoplasty (PK) in regard to corneal transplant suturing, when combined or not with vitreoretinal surgery.

Corneal Department, First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Retrospective review of the medical records of two patients who underwent a PK and a combined PK and vitreoretinal surgery, respectively, in the First Department of Ophthalmology, G. Gennimatas Hospital, in Athens, Greece.

A 23-year-old man and a 63-year-old woman presented to the corneal department with a central corneal opacity in their left eye following a perforating corneal injury. Both patients were aphakic in the left eye. The posterior eye segment of the male patient had no pathological changes, whereas the female patient suffered from vitreous hemorrhage and a suspected retinal detachment. Their visual acuity pre-operatively was hand movement and light perception, respectively. A PK was decided for the male patient and a combined PK and vitreoretinal surgery using temporary keratoprosthesis for the female patient. The former developed positive vitreous pressure intra-operatively managed with dry vitrectomy. In the latter case, vitrectomy was eventually not performed due to the discovery of submacular blood without retinal detachment intra-operatively. As trocars had already been placed, a continuous infusion system proved to be of assistance during the open-sky phase, stabilizing the tension when cardinal sutures were placed.

A continuous inflow of an irrigating solution, as such implemented during vitrectomy, can facilitate the placement of the four cardinal sutures during PK.