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Abstract #6150 Published in IGR 2-2
Incidence and risk factors of intraocular pressure elevation following penetrating keratoplasty
Nguyen NX; Langenbucher A; Seitz B; Küchle MKlinische Monatsblätter für Augenheilkunde 2000; 217: 77-81
PURPOSE: The aim of this study was to evaluate the incidence, risk factors and management of glaucoma following penetrating keratoplasty (PK), and to check for possible correlations with an indication for PK. PATIENTS AND METHODS: Five hundred and thirty-four eyes of 483 patients (aged 54.7 ± 19.8 years) that had undergone PK between 1989 and 1999 were retrospectively analyzed. The mean follow-up was 2.7 ± 1.8 years. According to the type of surgical procedure, patients were classified into five groups: 1. PK only (n = 291); 2. PK combined with extracapsular cataract extraction and intraocular lens (IOL) implantation (n = 124); 3. PK combined with secondary IOL implantation or IOL change (n = 32); 4. PK only after previous cataract surgery (n = 55); and 5. cataract surgery after PK (n = 32). Trephination was performed from the epithelial side in donor and recipient either by nonmechanical trephination with the 192 nm excimer laser (n = 444) or mechanical trephination (n = 90). Iridotomy was performed routinely during PK. The postoperative treatment with topical steroids was standardized. RESULTS: Preoperatively, glaucoma was diagnosed in 3.2% of all patients, with groups 3 and 4 showing a significantly larger number of glaucomatous eyes (15.6 and 18.9%, respectively). Most of the mild early intraocular pressure (IOP) elevations in groups 1 (3.4%) and 2 (3.0%) were controlled after six months (0.5 and 1.1%, respectively). Groups 3 and 4 most frequently had increased IOP and/or antiglaucomatous treatment (21.4 and 18.7%, respectively) six weeks postoperatively. In none of the groups did patients show a higher prevalence of persistent glaucoma from six months postoperatively than preoperatively throughout the follow-up period. Again, groups 3 and 4 presented with the largest number of cases of persistent glaucoma. In most eyes, the IOP was controlled by topical antiglaucomatous treatment. Serious forms seen in two patients with anterior synechiae caused by anterior chamber lenses required several filtering surgeries or pars plicata diathermy, respectively. One patient with pseudoexfoliation syndrome required laser trabeculoplasty. No cases of the so-called 'Urrets-Zavalia syndrome' were seen. CONCLUSIONS: The development of increased IOP after PK varied with the indication for keratoplasty. Post-keratoplasty glaucoma seems to be strongly associated with pre-existing anterior synechiae and/or simultaneous anterior chamber lens implant removal. Intraoperative iridotomy can prevent the development of acute angle-closure glaucoma after keratoplasty.
Dr. N.H. Nguyen, Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany. nhung.nguyen@augen.imed.uni-erlangen.de
Classification:
9.4.11.4 Glaucomas associated with corneal surgery (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders > 9.4.11 Glaucomas following intraocular surgery)
