Incidence and Risk Factors of Ocular Hypertension/Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty

Abstract

To evaluate the incidence, demographics, associated risk factors, management and clinical outcomes of ocular hypertension/glaucoma after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: A cohort review of 81 DSAEK cases was performed at Queen Victoria Hospital, United Kingdom. Patients with pre-existing glaucoma, transient increased IOP within the first 48 hours post-graft, additional post-transplant surgery, or failed to complete one year follow-up were excluded from the study. Ocular hypertension was defined as intraocular pressure (IOP) elevation >21mmHg or ≥6mmHg from baseline at any postoperative visit. The study looked at the incidence, risk factors, response to anti-glaucoma treatment, graft failure and best corrected visual acuity. Results: The incidence of post-DSAEK ocular hypertension and glaucoma was 51.9% and 13.6%, respectively. Steroid-induced IOP elevation was the most frequent cause, with an incidence of 38.3%. Risk factors such as pseudophakia (p=0.024) and preoperative IOP>16 (p=0.003) were found to be associated with post-DSAEK ocular hypertension. Preoperative IOP>16 had 5.27 times risk of IOP elevation. Eyes with graft dislocation and/or detachment were significantly associated with post-DSAEK glaucoma (p=0.038). There was no negative effect of OHT on visual acuity and graft status. Conclusion: Glaucoma and OHT are common postoperative complications of DSAEK. Although steroid-induced IOP elevation was the most frequent cause, there are other reasons associated with development of post-DSAEK glaucoma, including graft dislocation and detachment. Eyes with preoperative IOP>16 mm Hg may require a close monitoring of IOP. In addition, management by medical treatment results in good visual acuity and graft clarity.

Changes in the Visual Field Test after Descemet Stripping Automated Endothelial Keratoplasty in Advanced Glaucoma

“…The incidence of post-DSAEK ocular hypertension was reported as 51.9%, including steroid-induced IOP elevation [ 23 ]. The authors also found that pseudophakia ( p = 0.024) and preoperative IOP > 16 ( p = 0.003) were risk factors of post-DSAEK ocular hypertension.…”

Complications of Descemet stripping endothelial keratoplasty – A retrospective interventional study at a tertiary eye care center in Southern India

“…A study conducted by Elalfy et al . [ 11 ] showed that all eyes with steroid-induced IOP elevation were on the highest potency of steroid drop, dexamethasone 0.1%, and the earliest onset of IOP elevation was seen within a week. Steroid-induced IOP elevation could normally be controlled by tapering steroids, changing steroids, or starting antiglaucoma medication.…”

Outcomes of XEN Stent in Patients With Glaucoma and Previous Corneal Transplantation

“…The incidence of elevated IOP requiring treatment in eyes having undergone fullthickness or lamellar corneal transplantation ranges from 6% to 54%. [1][2][3][4][5][6][7][8][9][10][11][12] Keratoplasty can exacerbate preexisting glaucoma or contribute to new-onset glaucoma. Mechanisms include long-term use of topical steroids, prolonged inflammation, tight sutures with distortion of the angle, as well as direct trauma to the trabecular meshwork (TM) and/or formation of peripheral anterior synechiae.…”

“…Glaucoma and raised intraocular pressure (IOP) are known complications in eyes that have undergone previous corneal transplantation. The incidence of elevated IOP requiring treatment in eyes having undergone full-thickness or lamellar corneal transplantation ranges from 6% to 54% 1–12 . Keratoplasty can exacerbate preexisting glaucoma or contribute to new-onset glaucoma.…”