Glaukom und Keratoplastik

Abstract

Glaucoma and corneal disorders are often associated and are of diagnostic, therapeutic and prognostic relevance for each other. Glaucoma is already present in approximately 15% of eyes prior to keratoplasty, whereas in addition approximately 15% of cases are diagnosed following corneal transplantation. Corneal opacities, surface irregularities and pachymetric deviations from the norm can have a negative impact on tonometry, perimetry and morphological glaucoma diagnosis. Digital and intracameral tonometry as well as flash VEP to determine the visual potential can be helpful in this setting. Increased intraocular pressure (IOP), long-term application of antiglaucomatous medication or the use of antimetabolites in glaucoma surgery can all induce keratopathy. Therefore, intraocular pressure should be regulated prior to corneal transplantation. Risk factors for the evolution of glaucoma following corneal transplantation are the specific indication and surgical technique (e. g. combined corneal and cataract/vitreoretinal surgery), as well as postoperative steroid application and chamber angle synechiae. Unpreserved glaucoma medication without pro-inflammatory effects should be preferred following keratoplasty. In the long term surgery to control IOP is required in approximately 25% of eyes. The wider use of lamellar techniques for corneal transplantation is likely to reduce the incidence of secondary glaucoma.

Intraocular Pressure and Trabecular Meshwork Outflow Facility After Descemet Stripping Endothelial Keratoplasty

“…In posterior lamellar keratoplasty these risk factors are avoided, which may explain the lower rate of postoperative glaucoma after these procedures reported so far. 6 In a group of 1122 PK eyes, Kirkness and Ficker 21 found that 14% developed a manifest glaucoma postoperatively. So far the reported fractions of eyes developing glaucoma after posterior lamellar keratoplasty are highly variable.…”

“…4,5 In approximately 15% of cases a manifest glaucoma develops after PK. 6 This prevalence is described to be as low as 3% after posterior lamellar keratoplasty. 7 It was our aim to analyze trabecular meshwork outflow facility before and after posterior lamellar keratoplasty to find out whether it was significantly altered by the surgical techniques utilized.…”

Anterior Segment Analysis and Intraocular Pressure Elevation after Penetrating Keratoplasty and Posterior Lamellar Endothelial Keratoplasty

“…Additionally, one critical point of analysing data after PK and after DSEK is the measurement of IOP [19,56,57,58]. Corneal irregularity and increased corneal thickness may influence the validity of applanatory pressure measurement, especially in eyes with BK.…”

Results of sclerotonometry in the eyes with corneal leukomas and after keratoplasty to the depend on corneal thickness

“…Ââåäåíèå. Óðîâåíü îôòàëüìîòîíóñà ó áîëüíûõ ñ áåëüìàìè è ïîñëå êåðàòîïëàñòèêè ÿâëÿåòñÿ âàaeíûì äèàãíîñòè÷åñêèì êðèòåðèåì ïðè îöåíêå ãèäðîäèíàìèêè [1,5,7,10]. Íàèáîëåå ðàñïîñòðà-íåííûìè ÿâëÿþòñÿ ðîãîâè÷íûå ìåòîäû èçìåðåíèÿ âíóòðèãëàçíîãî äàâëåíèÿ (ÂÃÄ).…”