title: [Post-penetrating keratoplasty glaucoma management: report of 73 cases].
abstract: OBJECTIVE
  To report our experience in the therapeutic management of post-penetrating keratoplasty glaucoma.
  
  
  BACKGROUND
  Post-penetrating keratoplasty (PK) glaucoma is a true threat to visual prognosis. Therapeutic modalities are many, but the absence of a well-defined decision tree and the variable results of the various techniques renders management very difficult.
  
  
  METHODS
  This is a retrospective study including 73 eyes of 71 patients undergoing a penetrating keratoplasty. Patients who developed post-operative ocular hypertension were treated first with eye drops. In the case of failure, surgical procedures were recommended including trabeculectomy or glaucoma drainage devices. The intraocular pressure (IOP) assessed with applanation tonometer, side effects and graft failure were monitored.
  
  
  RESULTS
  The first medical treatment used for all patients was a betablocker, which allowed control of intraocular pressure in 80.6 % of eyes. Ahmed glaucoma valve was used in two cases with success and without graft failure. Trabeculectomy was necessary for five patients, three of whom developed immunological graft rejection within 6 to 9 months. We also observed that late ocular hypertension was statistically related to anatomic graft failure, independently of other preoperative factors.
  
  
  CONCLUSIONS
  Although hypotensive medication is still the first treatment for ocular hypertension after penetrating keratoplasty, a surgical procedure is sometimes required. Glaucoma drainage devices and trabeculectomy are widely practiced, leading to good outcomes, with the risk of rejection lower in cases involving mitomycin C. Cyclodestructive procedures should be reserved for surgical failures with significant visual loss.
authors.affiliation: Service d'ophtalmologie, hôpital Habib Thameur, 8, rue Ali Ben Ayed Montfleury, 1008 Tunis, Tunisie. Electronic address: houda.lajmi@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Lajmi
authors.affiliation: Service d'ophtalmologie, hôpital Habib Thameur, 8, rue Ali Ben Ayed Montfleury, 1008 Tunis, Tunisie.
authors.forename: M A
authors.initials: MA
authors.lastname: El Afrit
mesh_terms: D005260:Female; D005901:Glaucoma / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension; D012189:Retrospective Studies
keywords: Cycloaffaiblissement; Cyclodestructive procedure; Glaucoma; Glaucoma drainage devices; Glaucome; Graft rejection; Hypertonie oculaire; Implant de drainage; Kératoplastie transfixiante; Ocular hypertension; Penetrating keratoplasty; Rejet de greffe; Trabeculectomy; Trabéculectomie
vernacular_title: Prise en charge thérapeutique d'une hypertonie oculaire post-kératoplastie transfixiante : à propos de 73 cas.