title: Comparison of intraocular pressure post penetrating keratoplasty vs Descemet's stripping endothelial keratoplasty.
abstract: OBJECTIVE
  To compare the effect of Descemet's stripping endothelial keratoplasty (DSEK) with penetrating keratoplasty (PKP) on intraocular pressure (IOP) and use of ocular antihypertensives.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Thirty-five eyes in 33 patients undergoing PKP and 43 eyes in 38 patients undergoing DSEK were included in the analysis. Fifteen eyes undergoing PKP and 12 undergoing DSEK had diagnosed glaucoma. Patients undergoing corneal transplant because of trauma, keratoconus, pellucid marginal degeneration, or prior failed transplant were excluded.
  
  
  METHODS
  Charts were obtained for all patients who underwent PKP or DSEK by a single surgeon at the Ivey Eye Institute between 2003 and 2010. IOP and all IOP-lowering medications were recorded preoperatively and at 1, 4, 8, 12, and 24 weeks postoperatively. Complications, graft survival, and glaucoma surgeries were noted.
  
  
  RESULTS
  There was no significant difference in preoperative IOP between the 2 groups (p = 0.30). Postoperatively, IOP was significantly higher in the PKP group at 1 week (p < 0.01), 4 weeks (p < 0.01), and 8 and 12 weeks (p < 0.05), but not at 24 weeks (p = 0.62). Mean IOP increased significantly post-transplant in all groups (p < 0.05). In patients without glaucoma, postoperative IOP elevation requiring treatment occurred in 68% of PKP eyes and 23% of DSEK eyes. In patients with prior glaucoma, an increased requirement for ocular antihypertensives occurred in 60% of PKP eyes and 20% of DSEK eyes. Three trabeculectomies and 1 tube shunt were performed in the cohort with glaucoma undergoing PKP. No glaucoma surgery was required in the DSEK cohort.
  
  
  CONCLUSIONS
  Elevation of IOP requiring treatment occurred at a lower rate after DSEK compared with PKP. This difference was significant during the early postoperative course but nonsignificant at 24 weeks. Additional long-term studies on the effect of DSEK on glaucoma and IOP control are warranted.
authors.affiliation: University of Ottawa, Ottawa, Ont;. Electronic address: rahsharma@toh.on.ca.
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Sharma
authors.affiliation: Western University, London, Ont.
authors.forename: Lulu L C D
authors.initials: LL
authors.lastname: Bursztyn
authors.affiliation: Western University, London, Ont.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Golesic
authors.affiliation: Western University, London, Ont.
authors.forename: Rookaya
authors.initials: R
authors.lastname: Mather
authors.affiliation: Western University, London, Ont.
authors.forename: David P
authors.initials: DP
authors.lastname: Tingey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003316:Corneal Diseases / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D011183:Postoperative Complications; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents