Penetrating Keratoplasty and Glaucoma

Ayyala, Ramesh S.

doi:10.1016/s0039-6257(00)00141-7

Cited by 142 publications

(134 citation statements)

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“…The prevalence of traumatic IOP elevation and glaucoma after PKP is known to be elevated, ranging between 11 and 48%, [20][21][22][23][24] and is perhaps particularly elevated in eyes after penetrating eye injury. 25 Mechanisms for IOP elevation after PKP include postoperative edema and inflammation compromising the trabecular meshwork, angle scarring, peripheral anterior synechiae, retained viscoelastics, and steroid response.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for traumatic intraocular pressure elevation and traumatic glaucoma after open-globe injury

Bojikian

Stein

Slabaugh

et al. 2015

Eye

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Purpose To examine traumatic intraocular pressure (IOP) elevation and glaucoma after open-globe injury. Design Retrospective, observational case series. Methods Review of patients with open-globe repair at the University of Washington from May 1997 through July 2010. Traumatic IOP elevation and glaucoma were defined respectively as intraocular pressure (IOP) ≥ 22 mm Hg at 41 visit or need for glaucoma medication, and long-term (at least 3 months) glaucoma medication use or glaucoma surgery. Results We included 515 eyes (515 patients). The mean follow-up was 12.6 ± 20.1 months. One hundred twenty eyes (23.3%) developed traumatic IOP elevation, of which 32 (6.2%) developed glaucoma; six eyes (1.2%) required glaucoma surgery. The mean time to development of traumatic IOP elevation was 1.5 ± 3.4 months (range 1 day to 2 years). Kaplan-Meier 6-and 12-month estimates for development of traumatic IOP elevation were 27.2 and 32.4%, respectively, and for development of traumatic glaucoma were 7.1 and 11.0%, respectively. Multivariate regression revealed associations between traumatic IOP elevation and older age, and traumatic glaucoma and prior penetrating keratoplasty, initial vitreous hemorrhage, Zone II injury, and penetrating keratoplasty after open-globe repair. Traumatic glaucoma was controlled (IOP o22 mm Hg) in 78.1% of eyes at final follow-up, with mean IOP of 18.2 mm Hg on 1.7 medications. Conclusions Traumatic IOP elevation and glaucoma were common after visually salvageable open-globe injury. Most cases developed within 6 months, although longer follow-up remains important for case detection. Penetrating keratoplasty before or after repair, and vitreous hemorrhage were notable risk factors.

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Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for traumatic intraocular pressure elevation and traumatic glaucoma after open-globe injury

Bojikian

Stein

Slabaugh

et al. 2015

Eye

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“…4 The causes of glaucoma include progression of the synechial angle closure and response to topical steroids. These mechanisms should also work in eyes after PK for bullous keratopathy having previously trabeculectomy.…”

Section: Discussionmentioning

confidence: 99%

Penetrating keratoplasty for bullous keratopathy after trabeculectomy

Fukuoka

Honda

Usui

et al. 2008

Eye

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Purpose To evaluate the results of penetrating keratoplasty (PK) in eyes with bullous keratopathy having previously undergone trabeculectomy. Methods We reviewed medical records of patients that had undergone PK for bullous keratopathy having previously undergone trabeculectomy. A total of 34 eyes in 34 patients were included in the study. As a control group, we reviewed the medical records of 26 eyes in 26 patients that had no history of glaucoma and who had undergone PK for bullous keratopathy in the same period at the same institutes. Kaplan-Meier survival analysis was performed to estimate the cumulative probability of successful intraocular pressure (IOP) control, immune reaction-free graft, and graft survival. Results Visual acuity improved by more than two lines in 30-34 eyes (88%). Log-rank tests showed a statistically significant difference in the cumulative probability of successful IOP control between eyes with functioning blebs and eyes with non-functioning blebs (P ¼ 0.0005), but not between the experimental subjects of 34 eyes and the control group (P ¼ 0.198). The log-rank test did not show statistically significant differences in the cumulative probability of immune reactionfree grafts and graft failure between the subjects and the control group and between eyes with functioning blebs and eyes with non-functioning blebs. Conclusion The outcomes for PK in bullous keratopathy are good for patients having previously undergone trabeculectomy. Surgical procedures should be performed before PK in eyes with non-functioning blebs even when IOP is controllable with medication.

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“…Possible causes of immediate raised IOP after PKP are: rejection, vitreous in the anterior chamber, hyphaema, inflammation, response to steroids, and ghost cell glaucoma. 7 Viscoelastic retention after intraocular procedures is not common, as every effort is usually made to completely remove it at the end of the procedure. In our case, despite an apparent complete removal of Healon GV from the anterior chamber, Figure 1 Release of viscoelastic from the Molteno plate.…”

Section: Commentmentioning

confidence: 99%