Cornea sparing by endoscopically guided vitreoretinal surgery

PURPOSE: To report a series of eyes with acute severe corneal edema and vitreoretinal complications treated with endoscopic vitreous surgery without a keratoprosthesis to the cornea. DESIGN: Retrospective, small, noncomparative case series. PARTICIPANTS: Seven patients with unilateral acute severe corneal edema, poor view of the fundus, and vitreoretinal complications were reviewed. Five eyes were postcataract surgery, one eye was postpenetrating intraocular blunt trauma by a ferrous foreign body, and one eye had endophthalmitis. INTERVENTION: Vitreous surgery was performed on each eye under the guidance of endoscopy. Topical steroid treatment was administered to the cornea for several weeks after the vitreoretinal surgery, until the corneal edema had been completely resolved. MAIN OUTCOME MEASURES AND RESULTS: The edematous corneas recovered within an average of 9 weeks (range, 6-13 weeks). The preoperative visual acuity ranged from 6/90 to hand motion at 0.5 m, and the final postoperative visual acuity was 6/30 or better after an average follow-up of 14 months (range, 3-23 months). CONCLUSIONS: (1) Endoscopic surgery for vitreoretinal complications in eyes with acute severe corneal edema can obviate keratoprosthesis and keratoplasty. (2) By minimizing further damage to the corneal endothelium, endoscopic vitreoretinal surgery might benefit corneal recovery.