Risk Factors for the Development of Ocular Hypertension After Keratoplasty: A Systematic Review

Abstract

Purpose: To identify risk factors for the development of ocular hypertension after keratoplasty. Methods: A systematic search in PubMed and Embase identified 67 relevant articles published between January 1990 and 2019. We preferentially searched for data on an intraocular pressure increase above 21 mmHg at 6 months or a threshold or time point close to that and reported whether the preoperative or intraoperative status of risk factors was defined. The results were presented in evidence tables, visualizing the direction of the association, whether univariate and/or multivariate analysis was performed, and the significance level (P < 0.05). Four researchers, blinded for the risk factors, independently assigned a level of evidence (definitely, probably, possibly, not associated). Consensus was met during group meetings. Results: From the 110 studied risk factors, pre-existing glaucoma, high preoperative IOP and combined keratoplasty with removal or exchange of an intraocular lens (IOL) were definitely associated with an increased risk. In addition, if the pre-or postoperative lens status was undefined, aphakia and pseudophakia with the IOL in the anterior or posterior chamber were also definitely associated with an increased risk when compared to phakia. Glaucoma in the contralateral eye, indication of bullous keratopathy, African American descent, preoperative treatment with cyclosporine or olopatadine 0.1%, postoperative treatment with prednisolone acetate 1%, and combined surgery in general (ie, the type of surgeries undefined in primary studies) were probably associated. Multiple other identified risk factors lack sufficient evidence and need additional investigation. Conclusions: Risk factors with a definite association can help clinicians select patients at risk and adjust their follow-up and treatment. The other factors need further investigation.

Predicting psychological factors affecting regular physical activity in hypertensive patients: Application of health action process approach model

“…Furthermore, 50% of ischaemic heart disease and 25% of cardiovascular diseases are attributable to hypertension (Perumareddi, 2019). Lifestyle changes along with major risk factors such as unhealthy eating habits, alcohol consumption, smoking, stress, obesity and overweight, and inactivity have a considerable impact on developing the prevalence of hypertension (Liesenborghs et al., 2020). Physical activity as an alternative non‐pharmacological strategy plays an effectual role in accelerating the healing process and preventing the complications associated with hypertension.…”

Challenges in the complex management of post-keratoplasty glaucoma

“…This is also the only criterion used by some authors to define post-keratoplasty glaucoma; other literature added the need of surgical or medical treatment for more than 4 weeks to lower the IOP. 19 , 20 , 24 Liesenborghs and colleagues 19 also mention a persistently increased IOP greater than 10 mm Hg compared to the baseline value with or without medical or surgical treatment as a widely used cutoff for post-keratoplasty glaucoma. This is specified in some papers by the conditions of visual-field loss and optic nerve head changes.…”

“… 20 , 23 , 25 , 29 Liesenborghs and colleagues focused on studies with 6-month outcomes of IOP measurement. 19 In this setup, they avoid incorrect IOP data due to early postoperative fluctuations. Furthermore, the lack of widely used gold standards for IOP control after keratoplasty and other outcome measures lead to varying reports about the development of post-keratoplasty glaucoma.…”

“…They accentuated the differential incidence of 37% in phakic eyes and of 88% in aphakic eyes. 7 , 18 Liesenborghs and colleagues 19 published a semiquantitative systematic review about risk factors for the development of ocular hypertension after keratoplasty. They identified 110 risk factors out of 76 relevant articles (1993–2019) and defined preexisting glaucoma, high preoperative IOP, and combined keratoplasty with removal or exchange of an intraocular lens (IOL) as definitely associated with an increased risk of ocular hypertension after keratoplasty.…”

“…Furthermore, comparing aphakia and pseudophakia (with anterior or posterior chamber IOL) to phakic lens status, the first mentioned was also described to be definitely associated with an increased risk. Liesenborghs and colleagues 19 defined the following cases as probably associated with an increased risk of ocular hypertension after keratoplasty: glaucoma in the contralateral eye, indication of bullous keratopathy, African American descent, preoperative treatment with cyclosporine or olopatadine 0.1%, postoperative treatment with prednisolone acetate 1%, and combined surgery. Another meta-analysis from 2017 20 focusing on only post-PK glaucoma describes similar pre- and intraoperative risk factors, which largely coincide with the results of Liesenborghs and colleagues.…”