Cystoid Macular Edema After Aphakic Penetrating Keratoplasty

Abstract

Aphakic penetrating keratoplasty (APKP) and combined penetrating keratoplasty with lens extraction (CPKP) are highly successful surgical procedures, with clear corneas occurring in over 90% of cases. However, macular problems tend to develop or appear postoperatively, and visual acuity is disappointing, principally because of either cystoid macular edema (CME) or pre-existing macular degeneration. To determine whether vitreous manipulation at the time of surgery alters the macular outcome, 132 eyes were studied prospectively. Eighty-four of these had pre-existing aphakia and all underwent anterior vitrectomy at the time of APKP. Forty-eight eyes were planned for CPKP and were randomly assigned to one group that had anterior vitrectomy or to a second group that had no vitrectomy at the time of CPKP. The incidence of clinically significant and angiographically documented CME at six months postoperative was 35/84 (42%) in APKP eyes, 9/48 (19%) in CPKP eyes, 8/24 (33%) in CPKP eyes with vitrectomy, and 1/24 (4%) in CPKP eyes without vitrectomy. The data strongly suggest that transpupillary anterior vitrectomy at the time of penetrating keratoplasty, as compared with no vitreous manipulation at all, may contribute to a high incidence of postoperative persistent CME.