Post-penetrating keratoplasty glaucoma: risk factors, management and visual outcome.
OBJECTIVE
To evaluate the incidence, associated risk factors, graft status and treatment modalities in patients with post-penetrating keratoplasty glaucoma.


METHODS
A retrospective analysis of 747 consecutive penetrating keratoplasties was undertaken at a tertiary eye care centre. The frequency of post-penetrating keratoplasty glaucoma was determined and correlated with the pre-operative corneal diagnosis, lens status and associated surgeries performed during penetrating keratoplasty. The response to antiglaucoma therapy (i.e. medical, surgical or cyclo-destructive procedures) and graft outcome was also evaluated.


RESULTS
The incidence of post-penetrating keratoplasty glaucoma was 10.6% (79/747). Pre-operative corneal diagnosis of adherent leucomas was significantly associated with the development of postoperative glaucoma. Post-penetrating keratoplasty glaucoma was significantly higher in aphakes (odds ratio (OR) 6.6; confidence interval (CI) 3.81-11.69) compared with phakic or pseudophakic eyes. Associated vitrectomy (OR 2.32; CI 1.16-4.73) and anterior segment reconstruction (OR 3.31; CI 1.43-7.72) were other high-risk factors. Most patients responded to medical therapy (41/79; 51.9%), whereas filtering surgery and cyclo-destructive procedures were performed in 29.1 (23/79) and 19% (15/79) of eyes, respectively. Despite clear grafts in 39 eyes (49.4%), visual acuity of 6/18 or better was achieved in 15 eyes (18.9%).


CONCLUSIONS
A high incidence of post-penetrating keratoplasty glaucoma occurs in eyes with adherent leucomas. Anterior vitrectomy and associated surgeries further accentuate the risk Anti-glaucoma therapy may not achieve optimum visual outcome, despite a clear graft.
Sihota
R
R
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.
Sharma
N
N
Panda
A
A
Aggarwal
H C
HC
Singh
R
R
D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D018463:Filtering Surgery; D005500:Follow-Up Studies; D005901:Glaucoma / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure; D007498:Iris / Q000601:surgery; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014792:Visual Acuity
D000959:Antihypertensive Agents