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OCULAR HYPERTENSION AFTER PENETRATING KERATOPLASTY
F Orucov, E Strassman, D Landau, J Frucht-Pery and A Solomon,
Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Authors have no financial interests in any of the mentioned products or companies
Glaucoma is one of the most frequent and severe
postoperative complications of penetrating keratoplasty
loss of endothelial cells → graft failure
Increased IOP
optic nerve damage → visual loss
Incidence of glaucoma after penetrating keratoplasty
Karesh JW, Am J Ophthalmol 96:160,1983
Thoft RA, Trans Am Acad Ophthalmol 1974;78:352-65
7,3%-33,6%
PURPOSE
This study evaluated the incidence and risk factors associated with Ocular Hypertension following penetrating keratoplasty
Patient Characteristics
Number of patients 146Age (years) 45 ± 20.8 ( 15 – 88)Sex Male 71(48.6%) Female 75(51.4%)
IOP (mm Hg) Mean ± SD 13.2 ± 3.7 Range 5-26 High IOP (n) 6(4.1%)
Follow-up 24.4±7.5 (12-41 mo.)
Pre-op antiglaucoma medications 33 (22.6%) pts.
1 medication 23 pts. 2 medications 7 pts. 3 medications 3 pts.
s/p trabeculectomy in 8 pts
Glaucoma Prior to PKP
Other
Perforation
Fuchs dyst.
Scar-HSK
Trauma
Dystrophies
BK(other)
Corn.scar
PBK
FG
KCN
KCN: 60(41.1%)
FG: 30(20.5%)
PBK: 19(13%)
SCAR: 12(8.2%)
TRAU: 6(4.1%)
HSK: 4(2.7%)
DISTR: 3(2.1%)
BK(other):3(2.1%
FUCH: 3(2.1%)
PERF: 2(1.4%)
ASTIG 1(0.7%)
ULC: 1(0.7%)
INT.KR:1(0.7%)
DIAGNOSIS
Previous ocular surgery (n=70)
Previous surgery Number Percentage
Cataract extraction 22 (15.1)PKP 20 (13.7)Triple procedure 10 (6.8)Trauma, Perforation repair 3 (2.1)Trabeculectomy + ECCE + PKP 3 (2.1)Trabeculectomy + PKP 2 (14)Trabeculectomy + ECCE 2 (1.4)Stem cell transplantation+AMT 2 (1.4)Trabeculectomy 1 (0.7)Vitrectomy + ECCE + PKP 1 (0.7)Retina detachment repair + Vitrectomy 1 (0.7)Retina detachment repair + cataract surgery 1 (0.7)LKP 1 (0.7)PRK 1 (0.7) Total 70 47.9
Size of graft: Mean 8.0 mm Range 7.0-9.0 mm
Oversize 0.25mm 0.50mm 134 pts. 16pts.
Sutures Interrupted 110 (76.1%) pts. Continuous 36 (23.9%) pts.
AD
DIT
ION
AL P
RO
CE
DU
RE
S
n=
21(1
4.4
%)
Triple proced
AC IOL ex+vitrectomy
ACIOL ex
Vitrectomy
AC IOL remov
number of eyes
1086420
1
3
3
6
8
Combined Procedures (with PKP) N=21 (14.4%)
Post-PKP Complications 30(20.5%)
pts.(%)Rejection 10 (6.8%)Failed Grafts 13 (8.9%)
Non-Healing ED 8 (5.5%) Infection 5 (3.4%)
Recurrent HSK 2 (1.4%)
Mean 27.1± 5.7mmHg (21-49mmHg)
Starting - 70.3 days after PKP Lasting - 15.6±16.8 days
Topical steroids n=69
Ocular Hypertension after PKP n=70 pts. (47.9%)
Ocular Hypertension after PKP
Hx of Preexisting Glaucoma New Glaucoma PN 25 45PostPKP IOP(mmHg) 29.7± 7.0 25.7±4.2 0.02 Starting Time(days) 39.2 ±57.4 87.6±157.6 0.014N. of Medications 1.5±0.7 1.1±0.36 0.001
Treatment pts. (%)
1 medication 47 (69.1%)2 medications 12 (17.6%) 3 medications 3 (4.4%)
Not responsive to anti-glaucoma treatment n=11(7.5%)
Glaucoma surgery n=3
Second Episode of High IOP n=35
Ocular Hypertension after PKP
Graft Failure in Patients with Postperative Glaucoma
• 9 of 13 failed grafts (P=0.107).
• Pre-existing glaucoma was not a cause for graft failure (p=0.152 chi-square test)
Significant Risk Factors
for Ocular Hypertension after PKP(Univariate analysis *)
Risk Factors P Value
Preexisting glaucoma p<0.001Previous ocular surgery p=0.011Donor oversize 0.50mm p=0.003Additional intraocular surgery p<0.001Pseudophakia, Aphakia p=0.001
*Chi-Square test
Multivariate Analysis
Preexisting glaucoma p=0.009
Previous ocular surgery p=0.86
Donor oversize 0.50mm p=0.07
Additional intraocular surgery p=0.007Pseudophakia,Aphakia p=0.729
Conclusions
• Ocular Hypertension is Common in Patients Post-PKP
• Pre-Operative Glaucoma and Additional Surgical Procedures are risk factors for Postoperative Ocular Hypertension
• Monitoring of IOP During all Visits after PKP
Summary
The incidence of one episode of ocular
hypertension after PKP is 47.7%Starting after 70 days
Second episode: 24%
7.5% do not respond to topical management
Recommended