Results of Combined Penetrating Keratoplasty and Pars Plana Vitrectomy Performed for Infectious Keratitis with Endophthalmitis Compared to Other Non-Infectious Indications: Series of 129 Eyes

TL;DR

This study compares outcomes of combined eye surgeries for infectious keratitis with endophthalmitis versus non-infectious cases, finding higher enucleation and visual improvement rates in the infectious group.

Contribution

The study provides a direct comparison of surgical outcomes for infectious versus non-infectious indications in combined PKP and vitrectomy.

Findings

The IKE group had a significantly higher enucleation rate compared to non-infectious cases.

Eyes in the IKE group showed a higher rate of significant visual improvement.

Improved visual outcomes in the IKE group were associated with fewer retinal complications.

Abstract

Background/Objectives: The aim of this study was to determine the frequency of the indications and compare the results and prognosis of combined penetrating keratoplasty (PKP) and vitreoretinal surgery (PKPVR) performed for infectious keratitis with endophthalmitis (IKE) to those performed for other non-infectious indications in a German university eye hospital. Methods: Medical records were searched for patients who underwent PKPVR between 2016 and 2024. Demographic data, indication, best corrected visual acuity (BCVA), and intraocular pressure (IOP) at the first and last visits; data on conservative and surgical treatment; and data on the development of phthisis bulbi and the need for enucleation were recorded. Results: A total of 129 eyes of 128 patients were included in this retrospective study (61 ± 22 years, male: 64%). Of these eyes, 50% were treated for IKE and 50% for other non-infectious indications. The mean follow-up time was 24 ± 23 months, BCVA improved from logMAR 2.3 ± 0.5 to 2.0 ± 0.7 at the last visit (p < 0.01), and the percentage of severe visual impairment (logMAR ≥ 1.3) decreased postoperatively from 97% to 86%. A total of 9/129 eyes were eventually enucleated (7%), and another 5/129 had developed phthisis bulbi at the last visit (4%). Compared to the non-infectious group, the IKE-group had a significantly higher enucleation rate (p = 0.05) and also a higher rate of significant visual improvement (from logMAR ≥ 1.3 to <1.3) (p = 0.04). Eyes which achieved a significant BCVA improvement in the IKE-group had a significantly lower rate of retinal infiltration, hemorrhage, and ischemia (p = 0.03). Conclusions: PKPVR is an indispensable procedure for eliminating infection in eyes with IKE. Compared to other non-infectious indications, the IKE-group had the highest rate of both enucleation and significant BCVA improvement.

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