Incidence, Pathophysiology, Complications, and Management of Positive Vitreous Pressure During Penetrating Keratoplasty: A Literature Review

Abstract

Positive vitreous pressure (PVP) is common during open anterior segment surgery and penetrating keratoplasty (PKP) has a reported incidence rate of 40–50%. Despite adequate perioperative preventive precautions, positive pressure occurs during surgery and optimum management of PVP is required to avoid serious complications. Many pharmacological and mechanical approaches can be employed either preoperatively or intraoperatively to decrease vitreous pressure. Surgical techniques such as graft-over-host technique, the modified graft-over-host technique, techniques employed mattress sutures and needle, or Vitreous aspiration or vitrectomy can be effectively used to manage intraoperative PVP during PPK. This article reviews the incidence, risk factors, prevention, and different approaches to the management of positive vitreous pressure during PKP to analyze the available evidence in order to improve the safety profile of PKP and prevent sight-threatening complications.

Enhanced Surgical Safety through Protective Penetrating Keratoplasty: A Retrospective Analysis of 22 Cases

“…In patients with PBK, particularly those postcataract extraction with IOL implantation, traditional PK presents specific risks. The incidence of complications like positive vitreous pressure in traditional PK is reported to be around 40–50% [ 6 ]. These complications can lead to serious issues such as IOL dislocation, haptic rupture, persistently shallow anterior chamber, recurrent iris prolapse, and vitreous prolapse.…”

“…However, it carries notable risks, especially owing to its open-sky nature during surgery. This open-sky approach can lead to complications like positive vitreous pressure, observed in approximately 40–50% of cases [ 6 ]. Positive vitreous pressure can manifest as a persistently shallow anterior chamber, recurrent iris prolapse, zonular rupture, and complications during cataract extraction such as posterior capsule bulging or rupture, vitreous prolapse, and lens prolapse [ 7 ].…”

Simultaneous Deep Anterior Lamellar Keratoplasty and Descemet Membrane Endothelial Keratoplasty for Corneal Endothelial Failure With Stromal Scarring

“…As an open-sky procedures, PK is susceptible to complications because of positive vitreous pressure, which can result in sight-threatening complications such as vitreous loss, lens expulsion, choroidal detachment, choroidal effusion, and suprachoroidal or expulsive hemorrhage. 6 In comparison with PK, this procedure avoids complications associated with an open-sky surgery. This procedure may potentially result in reduced immunological reactions compared with full-thickness keratoplasty.…”