Turbid Vitreous Prolapse after Penetrating Keratoplasty. Limbal Vitrectomy. Wound Suture Closure.

追加: 2026-05-16

[00:00:00]Hi, this is Brian Kim. I want to share with you this case of a patient who had a corial ulcer and then penetrating kertolasty. This patient was pseudophagic and had an open posterior capsule. So after everything was said and done, the patient was healing well, doing well. But I noticed that there was a large clump of turbid vitrius in the anterior chamber within the pupilary opening and this became more manifest over time as the patient was healing.

[00:00:23]But then there was also some areas of loosening of the sutures. And in these areas there was some vitrius to the wound as well. Even though there was no vitrius that was externalized, I surmised that this vitrius to the wound also led to some of these sutures prematurely becoming loose. This is the patient. You can see that the pupil is not perfectly round to the 9:00 position on the screen. You can see there's a little peeking of the iris which is again showing the vitrius to the wound.

[00:00:52]You can see the turbidity of the vitrius in the anterior chamber as well. So I'm making a paracentesis incision first on the right side and then the left side.

[00:01:02]And these are going to be the incisions for the entire case. I'm going to perform limal petrectomy trying to make sure I stay away from the sutures.

[00:01:17]And so that's So I'm very carefully wiggling. You can see on the left side is a vitrector and on the right side is the irrigation canula. And immediately as I perform the limbo viterectomy that turbid vitrius is completely evacuated and I'm just going around making sure I lice any vitrius to the wound. So again, you can see there's quite a few sutures here that I had to remove prematurely.

[00:01:54]And that is because I believe there was some vitrius within the wound and it just caused that suture to become loose. So I had to take those sutures out. And so this patient is that's I believe around 6 months posttop.

[00:02:14]And so those sutures need to stay in a little bit longer. So, while I was in there, I decided I'm going to go ahead and replace those sutures.

[00:02:24]So, I go ahead and switch hands first and go in with vitrector on the right side.

[00:02:30]And this infusion can a little bit thick. So, I'm just having to wiggle a little bit to get through the incision.

[00:02:36]And I'm making sure I get rid of all the vitrius in the anterior chamber as well as any vitrius that might be to the wound. As you can see, limbo vitrectomy in this context I believe is a reasonable strategy because again the surgery was many months ago. There is no forces that's going to propagate more vitrius to come forward at this point and I'm minimizing how much vitrectomy I'm doing. And at this point you want to minimize any more irrigation and infusion because you don't want to encourage any more vitrius to come forward. So I push BSS as I take the infusion canula out and then I hydrate my incisions here and then I'll go ahead and replace those sutures. So this is 100 nylon suture. As you can see here I have this on 8x speed. You don't really need to see me putting sutures in. But the point is they had these extra sutures that I had to remove prematurely because they became loose prematurely again which is a little bit odd in these situations. And so I believe it's because of the vitrius in the AC vitrius to the wound. Again, it was hard to really appreciate at the time of the surgery, but then later on that vitrius developed some turbidity. And so that vitrius obviously wasn't that cloudy right after the original surgery, but over time the vitrius became more and more opaque. The patient's uncorrected vision after the original PKP surgery was around 2200ish. I was pleasantly surprised that even immediately after surgery went from 2200 uncorrected to 260. She was really really happy just by removing that turbid vitrius. So it made me a believer that turbid vitrius definitely can affect the vision.

[00:04:18]There's something about that vitrius prolapsing into the anterior chamber that makes it become more opaque. So if you ever encounter this situation, you can perform a limbo vitrectomy and removing that perid vitrius should improve the vision and give you an excellent outcome.

[00:04:35]So I hope this was helpful to you and I thank you for your attention.