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