COMBINED SURGERY OF PENETRATING KERATOPLASTY AND PARS PLANA VITRECTOMY IN ENDOPHTHALMITIS OF CORNEAL ORIGIN

Our main objective is to describe the technique of a combined Pars Plana Vitrectomy and Penetrating Keratoplasty in a patient with endophthalmitis of corneal origin and failure of previous corneal trasplants.  No relevants conflicts of interest to declare.

Report of a case from the Virgen de Valme University Hospital in Seville.

Description of a case with bibliographic review from the Virgen de Valme University Hospital in Seville.

64-year-old patient in follow-up by our service for more than 10 years for cicatricial ocular pemphigoid. Pecondary to Aspergillus fumigatus more than 10 years ago, for which he had to undergo an LE evisceration. He continued to be followed up by our service and in 2011 in OD (single eye) he presented VA of HM. Biomicroscopy revealed corneal conjunctivalization, with 360º corneal vascularization. The possibility of penetrating keratoplasty was ruled out at that time and he was proposed for Boston keratoprosthesis at another center, which was performed without incident in 2012. Six months later, he presented corneal ring infiltration. bottom, melting and vitritis. The microbiological culture was positive for Candida Glabatra, so he was admitted for treatment with voriconazole with an acceptable evolution. After the episode he maintained inferior thinning and 360º peripheral neovascularization developed. In 2012 he was reoperated on for a penetrating keratoplasty (1st KPP) removing the keratoprosthesis. Throughout 2013 and 2014 he developed a picture of endothelial failure for which a new penetrating keratoplasty was performed in 2014 (2nd KPP). After it, he remains in good control without endothelial failure, but begins with diffuse epitheliopathy in 2018. In 2019, a 5mmx5mm centrocorneal abscess with hypopyon accompanied by a practically holocorneal epithelial defect was observed. Microbiological culture was negative. After this process, a large central calcification with vascular attraction persisted. He underwent penetrating keratoplasty (3rd KPP) in 2020. He remained stable, but in 2022 after accidental trauma, he went to the emergency department, observing a new corneal abscess with vitreous occupation and a diagnosis of endophthalmitis. Microbiological culture was positive for Streptococcus pneumoniae. After its resolution, a calcium plaque appeared that occupies the entire corneal button. A PKP (4th time) with pars plana vitrectomy is again proposed, which is finally performed in May 2022.

Currently, although we are in an early postoperative period, the patient maintains a transparent corneal button without infiltrates or edema and the endophthalmitis has subsided.