Retinal Detachment Rare Following PK, Linked to Anterior Proliferative Vitreoretinopathy

The incidence of retinal detachment after penetrating keratoplasty was just 1.32% in this study, but cases, when present, were strongly associated with proliferative vitreoretinopathy. Photo: entokey.com. Click image to enlarge. A Chinese research team investigated the incidence of retinal detachment (RD) after penetrating keratoplasty (PK) in a retrospective review of 2,642 eyes. RD incidence, characteristics and outcomes of vitreoretinal surgery were analyzed.The incidence of RD after PK was 1.32%, with a mean follow-up of 7.7 years. Detachment occurred on average 28.3 months post-PK (sooner in eyes with multiple PKs). Most of the 35 cases (97.1%) received pars plana vitrectomy (PPV), with 11 eyes (32.4%) requiring endoscopic assistance due to opaque corneas.A unique traction RD pattern was identified in 23 eyes (65.7%), with anterior proliferative vitreoretinopathy (PVR) observed in 73.9% of cases during PPV. This caused RD without detectable retinal breaks due to anterior displacement of the retina and vitreous base. The ciliary body was also covered by the anterior PVR membrane, causing the refractory hypotony.While anterior PVR is an uncommon primary RD, it can occur after trauma or RD surgery. “It has been proposed that PVR may be an exaggerated wound healing response including three stages of inflammation, proliferation and remodeling,” the authors wrote in their paper, pointing to prior work showing that sustained intraocular inflammation “precedes the proliferation and contributes to PVR membrane formation.”Eyes with aphakia or pseudophakia following PK—especially those that underwent combined cataract and corneal procedures—may weaken the barrier between the anterior and posterior segments, they explained in their paper. “This anatomical disruption facilitates the anterior migration of vitreous and increases the risk of anterior vitreous traction and fibrocellular proliferation,” the authors wrote. “Moreover, anterior vitreous instability may be further exacerbated by forward displacement of vitreous due to lens removal or zonular weakness, and vitreous incarceration at corneal or limbal incisions.”In conclusion, RD following PK is a rare complication, characterized by severe anterior PVR, presenting significant surgical challenges. Effective management involves specialized surgical interventions, including vitrectomy, membrane peeling, retinotomy and silicone oil tamponade. Early detection and tailored surgical strategies are crucial for improving patient outcomes after PK. Click here for the journal source. Hao Y, Fang Y, Zheng P, et al. Characteristics and vitreoretinal management of retinal detachment in eyes after penetrating keratoplasty in a 10-year study. Retina. February 10, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.