Sterile keratolysis following pars plana vitrectomy for retinal detachment

Pars plana vitrectomy (PPV) with various forms of tamponade and retinopexy is often the primary treatment for retinal detachment. However, a rare but serious complication is sterile keratolysis. We therefore aimed to evaluate the prevalence and potential risk factors for the development of corneal ulceration following vitreoretinal surgery for retinal detachment.

This is a single-centre retrospective study including 14 cases of patients presenting to our department with sterile keratolysis involving the stroma after one or more PPVs for retinal detachment or vitreous hemorrhage. Time of primary procedure, time of onset of corneal complications, comorbidities, type of tamponade used, use of endophotocoagulation, cryoretinopexy and number of surgeries were recorded. Patients with additional comorbidities confounding a possible correlation were excluded from the case series.

A total of 14 patients were identified with corneal complications after pars plana vitrectomy for retinal detachment. Multiple vitrectomies were performed in 86% (12/14) of the cases. Surgical treatment consisted of six (43%) perforating keratoplasties and seven (50%) amniotic membrane keratoplasties in all but one patient. At an average of three months after the onset of corneal symptoms, the first corneal surgery was performed. Repeated corneal surgery was required in 4 patients (29%) and consisted of two penetrating keratoplasties and four amniotic membrane transplantation. Visual acuity at the first presentation of corneal complications was reduced (2.1 ± 0.6 logMAR), but was not statistically different from the visual acuity at baseline (1.6 ± 0.7 logMAR). At the last follow-up, visual acuity remained reduced at 1.8 ± 0.8 logMAR (p = 0.2).

The risk of sterile keratolysis seems to increase with excessive laser or cryo-retinopexy, use of silicone oil and repeated procedures. The initial vitrectomy was a complex surgery in all cases and required a longer operating time. Ciliary nerve damage of neurotrophic origin may be the cause of sterile keratolysis, and controlled retinopexy sparing the long ciliary nerves and avoiding cryotherapy may reduce the risk. Controlled studies are needed to investigate the causality between vitreoretinal surgery and sterile keratolysis.