Ocular Trauma, Silicone Oil Elevate Graft Failure Risk in Combined Surgeries

Previous ocular trauma and the presence of intraocular silicone oil after transplant are risk factors for graft failure after the use of a temporary keratoprosthesis (TKP) for combined penetrating keratoplasty (PK) and vitreoretinal surgery, according to research published in Cornea. These findings may facilitate patient selection and improve counseling about long-term graft potential in this patient population.

Researchers conducted a longitudinal, retrospective cohort study to evaluate graft outcomes after TKP for combined PK and vitreoretinal surgery and used multivariable analysis to identify risk factors for graft failure.

The team reviewed the electronic medical records for patients who underwent TKP for PK combined with vitreoretinal surgery at a single center between May 2007 and April 2021. They assessed 28 variables of interest as potential risk factors. The primary outcome of interest was corneal graft failure, defined as irreversible graft edema or opacification.

A total of 46 eyes of 46 patients (69.6% men and 30.4% women) who underwent combined surgery were included in the study. The primary PK indication was secondary corneal edema (52.2%), and the primary vitreoretinal surgery indication was retinal detachment (76.1%). The mean age at transplant was 55.7±18.6 years, and the mean follow-up duration was 31.8±30.5 months.

In the multivariable analysis, the researchers identified 2 factors significantly associated with graft failure, history of ocular trauma (hazard ratio [HR], 5.38; 95% confidence interval [CI], 1.53–18.91; P =.009) and intraocular silicone oil after transplant (HR, 5.67; 95% CI, 1.66–19.44; P =.006). 

They report that corneal graft failure occurred in 60.9% of all cases and in 33.3% of patients with no history of ocular trauma or intraocular silicone oil over the course of the study follow up. They found that patients with neither risk factor had a significantly lower probability of graft failure during follow up than patients who had both factors (P =.0493).

“In summary, TKP is a useful adjunct in combined PK and vitreoretinal surgery that can allow patients who would otherwise be possibly considered inoperable achieve both successful anatomical corneal and retinal outcomes,” the researchers report.

Limitations of the study included the retrospective design, use of only data available through clinical records, no records of graft donor characteristics nor severity of specific variables, heterogeneous follow-up duration, differences in postoperative management strategies and types of TKP used, and a small sample size.