THE IMPORTANCE OF OCULAR IMMUNOLOGICAL PRIVILEGE IN VITREORETINAL SURGERY COMBINED WITH PENETRATING CORNEAL GRAFTING
Published 2025 - 29th ESCRS Winter Meeting
Reference: PO166 | Type: Presented Poster & Poster | DOI: 10.82333/ed19-jj60
Authors: Rafał Leszczyński 1 , Łukasz Drzyzga 1 , Paulina Langosz* 1 , Krzysztof Eder 2 , Sebastian Sirek 3 , Aleksandra Górska 3 , Katarzyna Kowalska 3 , Anna Lorenc 3 , Wojciech Maruszczyk 1 , Dominik Dygas 3 , Dorota Wyględowska-Promieńska 3 , Adrian Smędowski 3
1Department of Ophthalmology ,Prof. Gibinski University Clinical Center ,Katowice,Poland, 2Department of Ophthalmology ,Prof. Gibinski University Clinical Center ,Katowice,Poland;Department of `ophthalmology, Faculty of Medical Sciences in Katowice,Medical University of Silesia ,Katowice,Poland, 3Department of Ophthalmology ,Prof. Gibinski University Clinical Center ,Katowice,Poland;Department of Ophthalmology ,Medical University of Silesia ,Katowice,Poland
Purpose
To present the relevance of ocular immunological privilege in vitreoretinal surgery and penetrating corneal grafting, based on a case report of a patient that underwent a secondary corneal grafting combined with vitrectomy, facilitated by the use of Eckard temporary keratoprosthesis at the Department of Ophthalmology at our facility.
Setting
Department of Ophthalmology, Prof. K. Gibinski University Clinical Center, Medical University of Silesia in Katowice, Poland
Methods
Case report: A 56-year-old female presented with acute keratitis combined with primary graft at our institution. Previous medical history included thyroid orbitopathy due to Graves-Basedow disease, cataract phacoemulsification, penetrating corneal grafting due to unspecified keratitis with previous malation of the cornea, as well as endophthalmitis within a year of the grafting. On presentation the BCVA (Snellen) was ⅝ in the right eye and light perception without localisation in the left. IOP was found to be 17 and 16 mmHg respectevily. Slit-lamp examination showed conjunctival injection in the left eye, as well as malation and oedema of the graft with inflammatory infiltrations localized especially around the sutures, as well as tyndallization in the anterior chamber combined with purulent discharge. AS-OCT and USG proved the presence of membranous inflammatory conglomerates both in the anterior and posterior segments of the eye. A decision was made to follow through with an urgent surgical treatment.
Results
A procedure performed under general anesthesia combined evacuation of the malated primary graft along with sutures, evacuation of the IOL, anterior and posterior segment clean-up along with removal of preretinal membranes, Ando method iridotomy, PFCL application and removal and silicone oil endotamponade, finished with secondary corneal grafting. The vitreoretinal part of the procedure has been facilitated by the use of Eckard temporary keratoprosthesis. No intra- or postprocedural complications were noticed and BCVA was found to be 3/50 (Snellen) after 18 months of observation and with a correction of +10,0 Dsph.
Conclusion
Immune privilege of the eye plays an important role in maintaining the graft. The use of a temporary keratoprosthesis during the procedure reduces complications. Disturbances in the functioning of the mechanisms that constitute the immune privilege of the eye require very intensive immunosuppressive treatment of the patient with Mycophenolate mofetil and/or Cyclosporine and/or steroid drugs.