Glaucoma in the Immediate Postoperative Period After Penetrating Keratoplasty

Chien, Ann M.; Schmidt, Courtland; Cohen, Elisabeth J.; Rajpal, Rajesh K.; Sperber, Laurence; Rapuano, Christopher J.; Moster, Marlene R.; Smith, Maura; Laibson, Peter R.

doi:10.1016/s0002-9394(14)73636-0

Cited by 87 publications

(50 citation statements)

References 6 publications

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“…[27][28][29] Reported risk factors for developing glaucoma after PK include simultaneous cataract extraction, trauma, previous PK, aphakic BK, and preexisting glaucoma. [30][31][32][33][34] Graft failure was 2.5 times greater in the PKG group, confirming the importance of detection and management of PKG.…”

Section: Discussionmentioning

confidence: 99%

Penetrating keratoplasty: indications, outcomes, and complications

Rahman

Carley

Hillarby

et al. 2008

Eye

125

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Purpose Corneal transplantation is the most common form of transplantation with approximately 2500 grafts undertaken annually in the United Kingdom. The modern day success of transplantation is attributed to eye bank storage techniques, ocular pharmacology, and improved surgical techniques. Methods This retrospective case note review identified 203 penetrating keratoplasties (PKs) performed during a period from 1 January 2000 to 31 December 2003 at Manchester Royal Eye Hospital. Preoperative risk factors, surgical technique, postoperative complications, and Snellen acuity were analysed. Results The mean age of the recipient group was 56.7 years, with 107 right eyes and 96 left eyes. The mean follow-up was 61 months. The overall 5-year survival was 82%, with keratoconus and corneal dystrophies at 93 and 89%, respectively. Visual acuity had improved to 6/12 or better in 48% of patients postoperatively, compared with 8% preoperatively. Forty-three donor grafts (21%) underwent at least a single episode of endothelial rejection. Glaucoma was a finding in 37 (18%) of patients following PK. In all, 16 grafts of 15 patients were noted to have suffered microbial keratitis (MK), an incidence of 8%. Conclusions PK is currently an effective long-term treatment option for improving visual function. An overall survival rate of 82% over 5 years is comparable with other published studies and is largely dependent on recipient factors. This report emphasises the significant complications of immunological rejection, glaucoma, and microbial keratitis, which continue to limit success.

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Section: Discussionmentioning

confidence: 99%

Penetrating keratoplasty: indications, outcomes, and complications

Rahman

Carley

Hillarby

et al. 2008

Eye

125

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“…Postoperative IOP elevation is not unique to vitreoretinal surgery. Chien et al [12] reported that IOP elevation [30 mmHg was found in 12% of patients at 2-5 h after penetrating keratoplasty. Nguyen et al [13] described an IOP spike that occurred in 3-12% of patients after penetrating keratoplasty combined with cataract surgery.…”

Section: Resultsmentioning

confidence: 99%

Intraocular pressure elevation in the early postoperative period after vitrectomy for rhegmatogenous retinal detachment

et al. 2011

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“…2,3 The incidence of glaucoma after keratoplasty varies from 9% to 31% in the early postoperative period and from 18 to 35% in the late postoperative period. 4,5 The aetiology of this disorder is multifactorial and the clear understanding of the various mechanisms that operate during different time frames following penetrating keratoplasty is essential to chalk out the appropriate management algorithms.…”

Section: Introductionmentioning

confidence: 99%

Preoperative risk factors and incidence of glaucoma after penetrating keratoplasty

Mn¹,

G²,

Hulinaykar³

et al. 2014

Int J Clin Trials

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Background: Glaucoma following penetrating keratoplasty is one of the serious complications due to its frequency of occurrence, difficulty in diagnosis and management, risk of graft failure and irreversible visual loss due to optic nerve damage. The incidence of glaucoma after keratoplasty varies from 9% to 31% in the early postoperative period and from 18 to 35% in the late postoperative period. The aetiology of this disorder is multifactorial and the clear understanding of the various mechanisms that operate during different time frames following penetrating keratoplasty is essential to chalk out the appropriate management algorithms. Methods: Prospective analysis of 100 consecutive eyes which underwent penetrating keratoplasty during the period from September 2009 to December 2010 at Bangalore West Lions super speciality eye hospital was done. The patients were followed up for a minimum period of 9 months. Results: Out of 100 patients mean age distribution was 47 ± 11 years. Of the 100 patients male 68% and 32 female (32%). Out of 100 eyes 38% of them had vision <6/60, 36% of them had vision between 6//36-6/18 and 26% of them between 6/18-6/6. Raised intraocular pressure was found in 15 out of 100 eyes. Mean raise in intraocular pressure was 29 mmHg ± 1.5 mmHg. Out of 15 patients 4 were steroid responders. Mean time of diagnosis of raised intraocular pressure was 5 ± 9.5 months. Pseudophakic Bullous Keratopathy (PBK) in 5 (33.3%) patients, aphakic bullous keratopathy (ABK) in 3 (20%) patients, graft rejection in 2 (13.3%) patients and one each patient (6.7%) of corneal scar, adherent leucoma, chemical injury and congenital hereditary endothelial dystrophy. Aphakic group was at higher risk compared to the other groups and there was not much difference between the phakic and the pseudophakic group. Conclusions: Post penetrating keratoplasty glaucoma continues to be a clinical problem that can be sight threatening in its clinical outcome. It is mandatory that intraocular pressure is monitored on a regular basis. Recognition of the risk factors namely, indications, graft size, lenticular status & associated surgical procedure with penetrating keratoplasty would help in early diagnosis of post penetrating keratoplasty glaucoma. Most of these cases are amenable to medical management.

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Glaucoma in the Immediate Postoperative Period After Penetrating Keratoplasty

Cited by 87 publications

References 6 publications

Penetrating keratoplasty: indications, outcomes, and complications

Penetrating keratoplasty: indications, outcomes, and complications

Intraocular pressure elevation in the early postoperative period after vitrectomy for rhegmatogenous retinal detachment

Preoperative risk factors and incidence of glaucoma after penetrating keratoplasty

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