Correlation between age and corneal edema in pediatric patients with Peters anomaly.

PURPOSE: To evaluate corneal edema in different-aged pediatric patients with Peters anomaly and to correlate in vivo with ex vivo histopathologic findings. METHODS: A retrospective cross-sectional study was performed. The medical records of patients diagnosed with Peters anomaly who underwent examination under anesthesia (EUA) between 2011 and 2015 were reviewed. Eyes in which central corneal thickness (CCT) measurements were taken were included. The thickest point in the CCT pachymetric map was used to objectively quantify corneal edema. Correlation between CCT and age was calculated. Additionally, a retrospective review of histopathologic studies of excised corneal buttons from pediatric eyes with Peters anomaly between 2011 and 2015 was performed. RESULTS: Eighteen eyes of 12 children were included. Mean age was 14 ± 15 months, and mean CCT was 842 ± 304 µm. A significant inverse correlation was noted between the CCT and the age of the patients, with lower CCT values in older children (r = 0.6; P = 0.01). Seven excised corneal buttons that underwent penetrating keratoplasty were reviewed. All corneal buttons showed absence of Descemet membrane and localized absence of endothelium. However, three specimens showed presence of corneal endothelium in areas of absent or attenuated Descemet membrane. CONCLUSIONS: In Peters anomaly, the CCT decreases with age, possibly due to a decrease in corneal edema. Histopathologic studies show cases of endothelial expansion in areas of absent or attenuated Descemet membrane. This may contribute to improved endothelial function and decreased edema with age.

Accelerated versus conventional corneal crosslinking for refractive instability: an update.

PURPOSE OF REVIEW: Corneal crosslinking (CXL) is a relatively new treatment modality offering refractive stability in patients with ectatic disorders. The procedure as initially described (Dresden protocol) is time consuming; accelerated protocols have been lately developed. The purpose of this review is to present the recent findings regarding the comparison of accelerated CXL with the conventional Dresden protocol. RECENT FINDINGS: A variety of accelerated protocols are described in the literature. Safety and efficacy of the procedures with regard to stability seem to be equivalent in initial studies but indirect measures of efficacy, such as demarcation line depth and laboratory measurements, do not always confirm equivalence of accelerated protocols in comparison to conventional one. Modified accelerated protocols must be developed in order to overcome this. SUMMARY: Accelerated CXL protocols seem to be a valid alternative to the conventional protocol; however, more comparative long term studies are needed to confirm the validity and to elucidate which accelerated protocol is ideal in each case.

Wavelike Interface Opacities After Descemet-Stripping Automated Endothelial Keratoplasty: 7-Year Follow-up.

PURPOSE: To report a case of wavelike interface opacities in a patient who underwent Descemet-stripping automated endothelial keratoplasty (DSAEK) and was managed conservatively over the course of 7 years. METHODS: A 65-year-old woman underwent DSAEK for pseudophakic bullous keratopathy. Textural wavelike opacities were noted in the graft-host interface 6 days postoperatively without evidence of anterior segment inflammation. The patient's vision was also initially limited by the presence of cystoid macular edema (CME). Six months postoperatively, CME had resolved but the patient's vision failed to improve better than 20/80 because of the persistent dense interface opacities. The patient refused to undergo graft exchange despite a suboptimal visual result and she therefore was observed over time. RESULTS: The interface opacities started to regress and her visual acuity improved to 20/30 by 9 months postoperatively. The opacities became gradually less prominent over the next few years, and at 7 years postoperatively, her best-corrected vision was 20/25. CONCLUSION: In this case, observation of this post-DSAEK complication rather than surgical intervention resulted in a favorable long-term visual outcome.

Anterior chamber angle evaluation with ultrasound biomicroscopy and optical coherence tomography in eyes implanted with a Crystalens.

This study employs optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) imaging as well as optical aberrometry to examine correlations between the anterior chamber angle aperture and visual acuity for near vision as well as coma along the horizontal and vertical axes in eyes implanted with an accommodative intraocular lens (Crystalens). A retrospective comparative consecutive case series of 22 eyes of 11 patients (5 males) uneventfully implanted with a Crystalens. Eyes with signs of posterior capsular opacification were excluded. All eyes were examined with 40 MHz UBM (Ellex Eyecubed) and spectral-domain OCT (Zeiss Visante). The angle aperture along the horizontal and vertical meridians was recorded based on the software of the systems. The coma root mean square (RMS) scores for the horizontal and vertical meridians were also recorded with the iTrace aberrometer. The anterior chamber angle was significantly wider along the horizontal axis compared with the vertical axis by UBM (46.37° and 44.20°, respectively) and by OCT (46.79° and 43.58°, respectively) (p = 0.02 in both cases, paired-samples t test). The correlations between the logMAR-converted Jaeger near vision score and the horizontal or vertical angle apertures was not statistically significant. Horizontal coma RMS was significantly inversely correlated with the horizontal angle aperture (r = -0.45, p = 0.03 and r = -0.39, p = 0.04 by OCT and UBM, respectively). Measurement of the horizontal angle aperture by the modalities used may represent an anatomical and clinical predictor of the optical aberrations induced by the Crystalens.

Descemet stripping endothelial keratoplasty for a failed penetrating keratoplasty graft in a pseudophakic patient with a toric intraocular lens: a case report.

BACKGROUND: To report a patient with penetrating keratoplasty (PKP) graft endothelial failure implanted with toric intraocular lens (IOL) who was treated with Descemet stripping endothelial keratoplasty (DSAEK). CASE PRESENTATION: A 40 year old male patient implanted with toric intraocular lens for the treatment of post PKP astigmatism, presented for the treatment of graft endothelial failure'. The patient had uncorrected distance visual acuity (UDVA) 20/200 not correcting with manifest refraction. The patient reported excellent visual acuity after cataract surgery and toric IOL implantation. DSAEK was performed in order to minimally affect keratometry and retain correspondence of the anterior cornea astigmatism with the toric IOL astigmatic power. Three months postoperatively the cornea was clear with no edema. UDVA was 20/40 and corrected distance visual acuity was 20/25 with +1.50-1.00 × 20. CONCLUSIONS: This report describes a unique case of DSAEK for treatment of a failed PKP in a patient previously implanted with a toric IOL. DSAEK was an effective alternative of PKP in this patient for the preservation of the toric IOL's effect.

Comparison of visual acuity charts in young adults and patients with diabetic retinopathy.

PURPOSE: To compare visual acuity (VA) assessed in healthy eyes and eyes with diabetic retinopathy (DR) using three different logMAR charts: the Sloan letter European-wide chart, the tumbling E chart, and the Landolt C chart. METHODS: Measurements on one eye of 40 volunteers (aged 29 ± 4 years) without visual impairment and 31 DR patients (aged 70 ± 9 years) with mild/moderate visual impairment were included. Visual acuity was assessed, with habitual refractive correction, using each of the three charts. Bland-Altman charts were constructed, and 95% limits of agreement were calculated to measure agreement. RESULTS: Mean VA in the group of young adults was -0.05 ± 0.10 (Sloan letter), -0.02 ± 0.13 (tumbling E), and 0.00 ± 0.12 (Landolt C) logMAR. Average VA estimates differed to a statistically significant extent between all charts. Mean VA in the DR group was 0.46 ± 0.25 (Sloan letter), 0.48 ± 0.26 (tumbling E), and 0.59 ± 0.28 (Landolt C). A statistically significant difference was observed for average Sloan letter versus Landolt C (p < 0.001) and tumbling E versus Landolt C (p < 0.001) acuities. Moreover, in healthy eyes, a moderate correlation (r = -0.38, p = 0.015) was found between the discrepancy in Sloan letter and Landolt C acuity and the mean VA estimate. The 95% limits of agreement were wide (more than approximately 0.2 logMAR for each comparison) and wider in the DR group chart comparisons than in healthy eyes. CONCLUSIONS: Landolt C charts resulted in worse VA estimates compared with letter and tumbling E charts in both young adults and visually impaired subjects with DR. These differences seem more pronounced in DR patients who exhibit worse VAs. The specific study population must be considered in comparing outcomes from different clinical practices.

Effect of blur and subsequent adaptation on visual acuity using letter and Landolt C charts: differences between emmetropes and myopes.

PURPOSE: To compare the effects of defocus induced blur and blur adaptation on visual acuity and to evaluate any differences between emmetropes and myopes using letter and Landolt C logMAR charts. METHODS: The sample consisted of 26 volunteers, with a mean age of 27 ± 3 years, comprising 13 emmetropes (spherical equivalent range: -0.63 to +0.50 D) and 13 myopes (spherical equivalent range: -0.75 to -5.00 D). Monocular visual acuity (VA) was measured in each eye using letter and Landolt C logMAR charts under the following conditions: (1) with the distance refractive correction, (2) immediately after exposure to +2.00 D defocus and (3) following 60 min of binocular adaptation to +2.00 D blur. Objective refraction at the beginning and at the end of the experimental procedure was evaluated. Averaged VA data between the two eyes were used for analysis. RESULTS: Deterioration in VA with +2.00 D defocus was greater in the emmetropes compared to myopes for both charts. The mean difference between the two refractive groups was more pronounced for the Landolt-C (0.17 logMAR) compared to the letter chart (0.10 logMAR). The reduction in VA with blur was related to the amount of the refractive error. Following 60 min of adaptation, a significant improvement in VA was observed in both groups that did not differ between the two charts. The improvement in VA following adaptation using the letter chart was linearly correlated with spherical equivalent refractive correction. CONCLUSIONS: Myopes show higher tolerance to retinal defocus compared to emmetropes, which could be attributed to previous blur experience. The effect of blur on VA is more pronounced using Landolt C optotypes than with letters. Prolonged exposure to blur results in equally improved performance for both refractive groups.

Long-Term Follow-Up of Combined Photorefractive Keratectomy and Corneal Crosslinking in Keratoconus Suspects.

PURPOSE: To present the long-term outcomes of photorefractive keratectomy (PRK) combined with accelerated corneal cross-linking (CXL) for refractive error correction in a series of keratoconus suspects. SETTING: University practice. DESIGN: Retrospective case series. METHODS: A series of patients with topographic findings suspicious for keratoconus underwent simultaneous PRK and prophylactic accelerated CXL (5 minutes with intensity of 18 mW/cm2) for the correction of their refractive error. The results were recorded for more than 4 years postoperatively. RESULTS: Ten eyes of 5 patients were included. Mean follow-up was 58.2 months (range from 54 to 62 months). Mean age at presentation was 25 years (range from 22 to 32 years). Mean spherical equivalent (SE) refraction was -2.76 (standard deviation [SD] 0.97D, range from -1.25 to -4.00 diopters [D]), while mean central corneal thickness was 511µm (SD 13µm, range from 485 to 536 µm). At last, follow-up 9 out of 10 eyes had SE refraction within ± 0.50D and all eyes had SE within ± 1.00D. None of the eyes lost any line of corrected distance visual acuity (CDVA), whereas 1 eye gained one line of CDVA. All eyes demonstrated stability of their results during the follow-up period. CONCLUSION: Simultaneous PRK followed by prophylactic accelerated CXL (PRK plus) appeared to be a safe and effective option for the correction of the refractive error in this series of keratoconus suspect patients, without compromising corneal stability for up to 5 years postoperatively.

Surgical and Perioperative Considerations for the Treatment of Cataract in Eyes with Glaucoma: A Literature Review.

Cataract surgery in the presence of glaucoma poses certain challenges that need to be addressed to offer the maximum benefit without complications. In this paper, we are reviewing the preoperative assessment, surgical options, the planning, and postoperative care. Cataract surgery can help reduce the intraocular pressure alone or combined with MIGS. When performed in patients with glaucoma, it can transiently increase the intraocular pressure and later on decrease the IOP to levels lower than the postoperative. The preoperative IOP and biometric characteristics are the main predictors of the postoperative course of IOP. The combination of cataract surgery with trabeculectomy remains controversial, in terms of best timing of each operation.

Surgical management of post-Descemet stripping automated endothelial keratoplasty interface haze associated with interface deposits.

We describe an effective technique for the management of graft-host interface haze associated with interface deposits after Descemet-stripping automated endothelial keratoplasty (DSAEK) with bimanual irrigation/aspiration. A Tan marginal dissector was used to separate the graft from the stroma in the nasal two-thirds of the graft-host interface. The aspiration handpiece was inserted in the interface through the nasal side-port corneal incision and a separate irrigation tip was placed in the anterior chamber (AC) through the temporal corneal paracentesis. Meticulous rinsing of the two-thirds of the interface area and the AC was performed. At the end of the procedure, air was injected into the AC to float the donor graft against the host stromal bed and facilitate graft adherence. Postoperative anterior segment optical coherence tomography and slit-lamp examination confirmed elimination of the interface haze-deposits and a well-attached graft. An improvement in visual acuity was noted.

Corneal cross-linking (CXL) combined with refractive surgery for the comprehensive management of keratoconus: CXL plus.

The past two decades have witnessed an unprecedented evolution in the management of keratoconus that demands a holistic approach comprising of inhibiting the ectatic progression as well as visual rehabilitation. The advent of corneal cross-linking (CXL) in the late 1990s resulted in long-term stabilization of the ectatic cornea along with limited reduction in corneal steepening and regularization of corneal curvature. However, CXL as a standalone procedure does not suffice in rehabilitating the functional vision especially in patients who are unwilling or intolerant towards contact lenses. The concept of "CXL plus" was proposed which incorporates adjunctive use of refractive procedures with CXL in order to overcome the optical inefficiency due to corneal irregularity, decrease the irregular astigmatism, correct the residual refractive error and improve functional visual outcome in keratoconus. Several refractive procedures such as conductive keratoplasty (CK), photorefractive keratectomy (PRK), transepithelial phototherapeutic keratectomy (t-PTK), intrastromal corneal ring segments (ICRS) implantation, phakic intraocular lens (PIOL) implantation and multiple other techniques have been combined with CXL to optimize and enhance the CXL outcome. This review aimed to summarize the different protocols of CXL plus, provide guidelines for selection of the optimum CXL plus technique and aid in decision-making for the comprehensive management of cases with primary keratoconus in addition to discussing the future and scope for innovations in the existing treatment protocols.

Accuracy of dynamic contour tonometry, Goldmann applanation tonometry, and Tono-Pen XL in edematous corneas.

PURPOSE: To investigate in vitro the accuracy of dynamic contour tonometry, Goldmann applanation tonometry, and Tono-Pen XL in edematous corneas. METHODS: Experimental study included 20 freshly enucleated porcine eyes. Epithelium was debrided, and eyes were divided in four groups. Groups were immersed in 35%, 40%, 50%, and 60% glycerin solutions for 3 hours. Subsequently, globes were mounted in a special holder, and their intraocular pressure was hydrostatically adjusted. Intraocular pressure was measured by means of dynamic contour tonometry, Goldmann applanation tonometry, and Tono-Pen XL while adjusting true intraocular pressure to 17, 33, and 50 mm Hg. Ultrasound pachymetry was performed. RESULTS: Mean corneal thickness was 914.5 ± 33.3 µm (730-1015 µm). In true intraocular pressure of 33 mm Hg, Goldmann applanation tonometry and dynamic contour tonometry significantly underestimated true intraocular pressure (mean Goldmann applanation tonometry: 14.7 ± 4.8 mm Hg, p < 0.001, mean dynamic contour tonometry: 21.6 ± 6.8, p < 0.001). Tono-Pen XL also underestimated, but difference was not statistically significant (Tono-Pen XL: 27.9 ± 9.7, p = 0.064). In true intraocular pressure of 50 mm Hg, all three methods significantly underestimated (Goldmann applanation tonometry: 17.6 ± 5.3 mm Hg, p < 0.001, dynamic contour tonometry: 26.8 ± 6.3 mm Hg, p < 0.001, Tono-Pen XL: 35.6 ± 8.4 mm Hg, p < 0.001). The error in measured intraocular pressure for each method (true minus measured intraocular pressure) was significantly correlated to true intraocular pressure (p < 0.001). The intraocular pressure measurements of each eye taken under true intraocular pressure of 17 and 33 mm Hg with the three methods were correlated to each other. Measurements taken under intraocular pressure of 50 mmHg were not correlated to each other. Corneal thickness was not correlated to intraocular pressure measurement. CONCLUSION: Goldmann applanation tonometry, dynamic contour tonometry, and Tono-Pen XL underestimate intraocular pressure when measured under edematous conditions. Tono-Pen XL showed better accuracy, especially in lower true intraocular pressure. The measurement error increases when true intraocular pressure increases in all three methods.

Corneal epithelial thickness profile in dry-eye disease.

BACKGROUND/OBJECTIVES: To characterize and evaluate the use of corneal epithelial profile maps generated by an ultrahigh-resolution optical coherence tomography (UHR-OCT) in the diagnosis and management of dry-eye disease (DED). SUBJECTS/METHODS: This prospective, interventional case-control study included 115 eyes of 71 subjects (52 DED and 19 controls) imaged using an UHR-OCT. Average, maximum, and minimum, range of corneal epithelial thicknesses were extracted from epithelial profile maps. Surface regularity was quantified using the range and variance of the epithelial thickness measured along a horizontal UHR-OCT scan. The variance of thickness measurements along a scan was named epithelial irregularity factor (EIF). Symptoms of 31 DED patients (55 eyes) were quantified by questionnaire and correlated to epithelial profile findings, fluorescein staining, tear breakup time, and Schirmer's test. Twenty-one DED eyes were administered autologous serum drops and follow-up UHR-OCT images were captured. RESULTS: DED patients had a highly irregular corneal epithelial surface compared with controls. Epithelial thickness profile variance (EIF) and range were significantly higher in DED as compared with controls (5.79 vs. 0.77, p < 0.001 and 7.6 vs. 4.6 µm, p < 0.001). Both parameters were highly significantly correlated with questionnaire scores (EIF: r = 0.778; p < 0.001, range: r = 0.737; p < 0.001). Follow-up showed a statistically significant reduction in epithelial thickness profile variance and range of treated patients ( p < 0.001). CONCLUSIONS: DED patients have irregular epithelial surface that can be quantified using UHR-OCT generated CEP maps. Epithelial thickness profile range and EIF correlate accurately with patients' symptoms and could be used to follow-up patients and response to treatment.

Late onset corneal haze after corneal cross-linking for progressive keratoconus.

PURPOSE: To present the case of a patient that underwent corneal crosslinking for progressive keratoconus and 18 months later revealed clinically significant corneal stromal haze. OBSERVATIONS: A 20-year-old male presented with progressive visual loss OU for the past few years. His corrected distance visual acuity (CDVA) OD was 20/30 (-2.75 -1.75 @55) and OS 20/30 (-0.50 -1.75@110). Corneal topography revealed keratoconus OU and the patient underwent corneal crosslinking according to the Dresden Protocol. The postoperative regimen included combined tobramycin and dexamethasone qid along with lubrication until epithelium healed and then fluorometholone qid with weekly tapering. At 3 months postoperatively, his topography was stable and his corrected distance visual acuity (CDVA) was 20/25 OU. On slit lamp examination, only clinically insignificant stromal haze was observed. At 18 months postoperatively, the patient reported vision deterioration. On examination his CDVA was 20/25 in right eye, and 20/40 in his left eye. Deep stromal haze was revealed in his central cornea, more dense in his left eye. Corneal topography was stable and the CDVA loss was attributed to the notable deep stromal haze. The patient was treated with dexamethasone qid with biweekly tapering. 18 months after corneal crosslinking, the patient demonstrated clinically significant stromal haze, most prominent OS. He was treated with dexamethasone qid. One month later his CDVA OS gradually improved to 20/25, and stromal haze was still noted but less dense. CONCLUSIONS AND IMPORTANCE: Late-onset deep corneal haze is a possible complication of corneal crosslinking in keratoconic patients.

Combined Corneal Wedge Resection And Corneal Cross-Linking For Pellucid Marginal Degeneration: A First Report.

BACKGROUND: Advanced pellucid marginal degeneration is a debilitating disease that warrants the use of surgery when the visual acuity is reduced and contact lenses are not tolerated anymore. It is traditionally managed with corneal transplantation, however alternative surgical options exist. Corneal wedge resection allows for good visual rehabilitation without the risks of tissue rejection. However topographical and refractive results are in some instance fluctuating. We present here the use of corneal cross-linking in order to stabilize the parameters on the long term. CASE PRESENTATION: We present here the case of a 53 years old patient with bilateral advanced pellucid marginal degeneration. As he is now intolerant to contact lenses a surgical option is offered to him. In order to avoid using donated tissue through corneal grafting we decide to perform a sectorial lamellar crescentric wedge excision of the thinner inferior part of the cornea involving the pellucid marginal degeneration and suture it. The first eye shows initial good results however after few months regression is observed. The second eye is then treated with the same surgical technique combined with cornea cross-linking. Long-term follow-up shows stabilization and absence of regression in the second eye up to eight months after the surgery. CONCLUSION: Combining corneal cross-linking with corneal wedge resection in the case of advanced pellucid marginal degeneration patients could be a good option in order to stabilize topographical and refractive results and reduces the risk of regression.

Femtosecond-Assisted Elliptical LASIK Flap for the Correction of Post-Arcuate Keratotomy Residual Astigmatism.

We report the application of an elliptical femtosecond laser-assisted in situ keratomileusis (LASIK) flap for the management of post-arcuate keratotomy (AK) residual astigmatism. An 82-year-old male was referred to our institute for evaluation of his right eye due to residual regular astigmatism 1 year after AK. On examination, uncorrected distance visual acuity (UDVA) was 20/50 and corrected distance visual acuity was 20/25 (+3.25 -5.50 × 125). Slit-lamp examination revealed two 70-arc length peripheral corneal incisions at the 7.50-mm zone. The patient underwent femtosecond-assisted LASIK for the correction of residual astigmatism. An elliptical LASIK flap was adjusted intraoperatively with a 2-dimension diameter of 7.98 × 6.69 mm in order to avoid intersection of the flap with the AK incisions. The short flap diameter was placed along the meridian of the incisions and the long diameter in the perpendicular meridian, corresponding to the excimer laser astigmatic ablation pattern. No intraoperative or postoperative complications were encountered. Six months postoperatively, UDVA improved to 20/25 with a manifest refraction of pl -0.75 × 5. No AK incision flap-related complications were observed.

Acute glufosinate-based herbicide treatment in rats leads to increased ocular interleukin-1ß and c-Fos protein levels, as well as intraocular pressure.

Glufosinate is a common herbicide with neurotoxic effects, leading to seizures, convulsions and memory loss. Glufosinate indirectly induces glutamate toxicity by inhibiting glutamine synthesis in astrocytes. Here, we studied the acute toxic effects of a glufosinate-based herbicide in rat optic nerve at three doses (40, 80 or 120 µM, equal to 714 or 21 mg/kg bw/day). Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, glucose, calcium, as well as creatinine concentrations were analyzed after 24, 48 and 72 h treatment. Intraocular pressure (IOP) (expressed as the average of both eyes) was measured with a rebound tonometer. Interleukin-1ß (IL-1ß) and c-Fos expression were determined by immunohistochemistry. The results established that the glufosinate-based herbicide significantly increased IL-1ß and c-Fos immunopositivity in the optic nerve (p < 0.05), concomitant with increased IOP. These results suggest that commercial formulations of glufosinate acutely affect the optic nerve.

Risk of Endophthalmitis in Boston Type 1 Keratoprosthesis Combined with Vitrectomy and Silicone Oil Insertion.

PURPOSE: To identify the incidence of endophthalmitis and visual outcomes in eyes with Boston type 1 keratoprosthesis combined with pars plana vitrectomy and silicone oil insertion (KPro + PPV + SOI) as compared to eyes receiving Boston type 1 keratoprosthesis (KPro) alone. PATIENTS AND METHODS: Retrospective chart review of 29 eyes of 27 patients with KPro having at least 12-month follow-up. Thirteen of these eyes had hypotony and/or retinal detachment in addition to corneal pathology and thus received KPro + PPV + SOI. Polymyxin-trimethoprim with a quinolone was used as chronic topical antibiotic prophylaxis in both groups after the first postoperative month. Outcome measures recorded at the 1-, 3-, 6-, 12-, and 24-month follow-up visits included best-corrected visual acuity (BCVA) and rates of postoperative complications. RESULTS: All the patients had completed 24-month follow-up except one case in the KPro group who lost to follow-up after 12-month visit. In the KPro + PPV + SOI group, no eyes had developed endophthalmitis by the 24-month follow-up visit versus 5 eyes of 5 patients in the uncombined KPro group (P=0.048). The 2-year cumulative endophthalmitis incidence was 31.2% in the KPro group versus zero in the KPro + PPV + SOI group (P=0.030). Four of these 5 eyes had vitreous taps with positive cultures; 2 were positive with Staphylococcus aureus, 1 with coagulase-negative staphylococci, and 1 with Streptococcus pneumoniae. Other complications included KPro extrusion (1 in each group), retinal detachment (2 in the KPro and 1 in the KPro + PPV + SOI group), newly developed glaucoma (2 in each group), and retroprosthetic membrane (9 in the KPro and 5 in the KPro + PPV + SOI group). The KPro group had better average preoperative BCVA compared to those of the KPro + PPV + SOI group (-2.29 ± 0.72 LogMAR, versus -2.95 ± 0.30 LogMAR; P=0.004). No statistically significant difference in BCVA was noted in subsequent follow-up visits. CONCLUSION: The addition of PPV and SOI to the KPro implantation in the eyes with corneal pathology, as well as hypotony and/or retinal detachment, is a safe and effective procedure for visual rehabilitation. Pars plana vitrectomy and silicone oil insertion may have a protective effect against the development of postoperative endophthalmitis in eyes receiving KPro.