Transient Keratoproshtesis After Ocular Trauma To Enhance Vitreoretinal Surgery: Case Series Report

To report a case series of transient keratoprosthesis used after ocular trauma to enhance visualization for vitreoretinal surgery. To highlight the benefits of a combined surgical anterior-posterior pole procedure to restores eye injured anatomy.

Ocular Trauma Clinic at Unidad Nacional de Oftalmología, Guatemala City, Central America

Three patients otherwise healthy with no pathologic ocular history known presented after penetrating ocular trauma to the Ocular Trauma Clinic. Patients reported mixed trauma mechanism that ended in an obscure visualization of ocular fundus due to corneal opacity. After initial management and corneal wounds repair, posterior AB mode ultrasound depicted inferior retinal detachment in one case; and secondary endophthalmitis in two cases

Since no direct fundus visualization was possible, a surgical combined approach was decided; a poly (methyl methacrylate) transient keratoprosthesis, the Dalma transient keratoprosthesis (DTK, a modification of the Landers—Foulks keratoprosthesis), was used to ensure a wide-angle visualization for posterior vitrectomy using a 3D visualization system. After vitrectomy, the DTK was removed and a penetrating keratoplasty was performed in all three cases using the same trephination for the DTK and preoperative care as needed was carried on

Ocular Trauma is a complex situation that sometimes requires multidisciplinary surgical approach to restore injured eye anatomy. When an obscured fundus visualization occurs due to corneal opacity but surgical intervention to the posterior pole is necessary, transient keratoprosthesis to enhance visualization is a viable option in order to make a combined approach that at the same surgical intervention aims to restore eye anatomy. More prospective and long-term studies are needed to evaluate safety and efficacy but it seems to be a reasonable surgical approach after ocular trauma in selected cases. Visual and refractive outcomes are associated with every unique case presentation