Intraocular pressure elevation and post-DSEK glaucoma after Descemet`s stripping endothelial keratoplasty

Abstract

IOP elevation after DSEK shows a high incidence. Pre-existing glaucoma increased the risk of developing IOP elevation and post-DSEK glaucoma. Although steroid-induced IOP elevation was the most frequent cause and could be treated effectively by tapering down steroid medication; there are other reasons why post-DSEK glaucoma developed. Management by medical treatment results in good visual acuity and graft survival.

Anterior Segment Analysis and Intraocular Pressure Elevation after Penetrating Keratoplasty and Posterior Lamellar Endothelial Keratoplasty

“…Standard postoperative topical treatment after DSEK was described by Maier et al [13]. Standard postoperative topical treatment after PK included a combination of steroid and antibiotic eye drops 5 times daily in combination with lubricant eye drops.…”

“…Single IOP measurements that met these criteria were classified as postoperative IOP elevation. All eyes with postoperative elevated IOP were categorized as described by Maier et al [13]. …”

“…Post-PK glaucoma occurred in 9-35% of cases [2,6,8,9,10,11]. In contrast to PK, the incidence of glaucoma after Descemet's stripping endothelial keratoplasty (DSEK) is less [1,12,13]. However, DSEK also induces IOP elevation and the reported incidence of IOP elevation after DSEK ranged from 31 to 60% [1,13,14].…”

“…Multiple studies found a high correlation between PAS and IOP elevation after PK and post-PK glaucoma [7,16,17,18,19,20,21,22]. After DSEK, steroid-related ocular IOP elevation was identified as a major cause [1,13]. Other factors that give high IOP after PK seem to be less important after DSEK - maybe due to the less invasive technique [12].…”

“…Other factors that give high IOP after PK seem to be less important after DSEK - maybe due to the less invasive technique [12]. Nevertheless, other factors like the development of PAS may also apply in DSEK [13]. …”