title: Long-term risk of intraocular pressure elevation and glaucoma escalation after deep anterior lamellar keratoplasty.
abstract: BACKGROUND
  To determine the prevalence and severity of intraocular pressure changes after deep anterior lamellar keratoplasty and its effect on visual function.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All patients undergoing deep anterior lamellar keratoplasty procedures at a tertiary referral centre (Leeds University Hospitals, UK) using a manual dissection technique.
  
  
  METHODS
  Case note review of all cases between the 1st of January 2000 and the 31st of December 2005.
  
  
  METHODS
  Raised intraocular pressure, glaucoma incidence or escalation.
  
  
  RESULTS
  Data were collected for 69 of eyes of 58 patients. The mean period of follow-up was 54.9 months (median 60, range 6-95 months). The initial diagnosis was keratoconus in 56 cases (81%), corneal scarring in four cases (5.8%), herpes simplex keratitis in four cases (5.8%), lattice dystrophy in four cases (5.8%) and one case of corneal dermoid. Temporarily intraocular pressure was thought to be related to topical steroid use occurred in 12 (17%) cases. Ocular hypertension requiring treatment occurred in three eyes. None of these eyes had progressive disc changes or visual field defects suggestive of glaucoma, and all had well-controlled intraocular pressure on topical, single-drug therapy. Overall, there was a small insignificant rise in intraocular pressure after deep anterior lamellar keratoplasty (P = 0.11).
  
  
  CONCLUSIONS
  The long-term risk of glaucoma following deep anterior lamellar keratoplasty using the manual dissection technique appears to be low. Ocular hypertension after deep anterior lamellar keratoplasty is infrequent and can be controlled on topical medication alone.
authors.affiliation: Department of Ophthalmology, St. James's University Hospital, Leeds, UK. fayyaz@doctors.net.uk
authors.forename: Fayyaz U
authors.initials: FU
authors.lastname: Musa
authors.forename: Savita
authors.initials: S
authors.lastname: Patil
authors.forename: Omar
authors.initials: O
authors.lastname: Rafiq
authors.forename: Peter
authors.initials: P
authors.lastname: Galloway
authors.forename: James
authors.initials: J
authors.lastname: Ball
authors.forename: Andrew
authors.initials: A
authors.lastname: Morrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult