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Abstract #6798 Published in IGR 4-1
Impact of increased intraocular pressure on long-term corneal endothelial cell density after penetrating keratoplasty
Nguyen NX; Langenbucher A; Seitz B; Kuchle M; Naumann GOHOphthalmologica 2002; 216: 40-44
PURPOSE: Apart from immunological graft rejection, persistently increased intraocular pressure (IOP) is one of the most important causes for graft failure after penetrating keratoplasty (PK). The purpose of this study was to assess the longitudinal development of IOP after PK and to investigate possible correlations with corneal endothelial cell density. METHODS: This longitudinal prospective study included 209 eyes after PK with a complete follow-up at three and six months before first suture removal (16 ± 5 months) and after complete suture removal (21 ± 5 months). At each examination, IOP was measured by Goldmann applanation tonometry. Endothelial cell density was assessed by specular microscopy (EM 1100, Tomey). The indications for PK were 48% keratoconus, 34% Fuchs' dystrophy, 5.4% stromal dystrophies, 8.6% secondary bullous keratopathy and 4% corneal scars. An iridotomy was performed routinely during PK. The postoperative treatment with topical steroids was standardized. RESULTS: Preoperatively, the mean IOP was 13.6 ± 2.9 mmHg with increased IOP (>21 mmHg) in 2.0% of eyes. After three months, the incidence of increased IOP (24.5 ± 4.6 mmHg) was highest (6.7%) and decreased thereafter to 3.0% after complete suture removal. No patients showed IOP higher than 30 mmHg. A persistently increased IOP for more than three months was seen in 2% of patients. At three months postoperatively, the mean endothelial cell density was 1977 ± 496 mm2 and did not decrease significantly (p > 0.05) until six months (1771 ± 507 cells/mm2). At the end of the follow-up period, the mean endothelial cell density was significantly reduced (1347 ± 501 cells/mm2). There was no significant correlation between IOP and mean endothelial cell density at any postoperative examination stage (p > 0.24). Patients with persistently increased IOP for more than three months did not have significantly different endothelial cell densities in comparison with those without increased IOP. CONCLUSIONS: From six months after PK, the incidence of increased IOP was not higher than the preoperative level. Mild to moderate temporary IOP elevations after PK do not seem to affect the endothelial cell density of the graft until complete suture removal. Further long-term studies will be necessary to assess the clinical relevance of these observations.
Dr. N.X. Nguyen, Department of Ophthalmology, University of Erlangen-Nurnberg, Schwabachanlage 6, D-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)
