Penetrating keratoplasty with vitreoretinal surgery using the Eckardt temporary keratoprosthesis: modified technique allowing use of larger corneal grafts.

UNLABELLED: We report our experience with the Eckardt temporary keratoprosthesis including a technique modification allowing use of larger corneal grafts. We combined penetrating keratoplasty with vitreoretinal surgery using the Eckardt keratoprosthesis in 24 eyes of 24 patients in two patient groups: trauma (n = 11) and nontrauma (n = 13). Our technique modification involved centering a larger partial trephination for the donor cornea around the smaller trephination used for the keratoprosthesis. After the keratoprosthesis was removed, we excised host cornea graft. With the exception of visual acuity (VA), the outcomes were similar for both trauma and nontrauma groups, and combined results were as follows. Corneal grafts remained clear in 71% of patients at a mean follow-up period of 16 +/- 3 (SE) months. For the trauma and nontrauma groups, VA improved in 82 and 23%, and decreased in 18% and 38.5%, respectively. Postoperative loss of VA was due primarily to retinal scarring (47%) and phthisis bulbi (37%). Only one case of graft rejection occurred. Postoperatively, the larger corneal grafts (8.0 and 8.5 mm) were less steep, and residual astigmatism was more easily managed than with the "recommended" (7.2 mm) size.
CONCLUSIONS: Larger corneal grafts allow less astigmatism and a more normal corneal curvature. Theoretical advantages also include faster rehabilitation of vision, better predictability for intraocular lens implant power calculations, and transplantation of more endothelial cells. The Eckardt will continue to be a useful tool and our technique modification allowing use of larger corneal grafts should enhance its utility.