title: Incidence and Risk Factors of Elevated Intraocular Pressure Following Deep Anterior Lamellar Keratoplasty.
abstract: OBJECTIVE
  To report the incidence and risk factors of elevated IOP following deep anterior lamellar keratoplasty (DALK).
  
  
  METHODS
  A retrospective case series.
  
  
  METHODS
  A retrospective study investigating the 5-year incidence of raised IOP following DALK cases performed from 2004 to 2008 in a tertiary center. Patients with less than 6 months of follow-up were excluded. Elevated IOP was defined as IOP >21 mm Hg.
  
  
  RESULTS
  An episode of elevated IOP occurred in 36.1% of cases (44/122 cases), 11.4% (n = 5) occurring within the first week. The average duration of raised IOP was 48.9 (SD: 65.5) days. Causes included pupil block from air, swollen grafts, and corticosteroid response. Surgical intervention to lower IOP was required in 3 cases (6.8%). In multivariate analyses, the use of Olopatadine 0.1% or cyclosporine eye drops before DALK (OR = 14.51, 95% CI = 1.43-147.23) and use of topical prednisolone acetate 1% compared with dexamethasone 0.1% post DALK (OR = 4.79, 95% CI = 0.73-31.52) were associated with higher rates of elevated IOP post DALK. At 5 years post DALK, 3 of 71 cases (4.48%) developed de novo glaucomatous field defects, and 1 case with pre-existing glaucoma had progression of glaucomatous field defect.
  
  
  CONCLUSIONS
  DALK was associated with a significant incidence of transiently elevated IOP postoperatively, but had a low incidence of de novo glaucoma at 5 years in our study. Risk factors for raised IOP post DALK included the use of topical prednisolone acetate 1% compared with dexamethasone 0.1%, and the use of Olopatadine 0.1% or any concentration of cyclosporine eye drops prior to DALK.
authors: Singapore National Eye Centre, Singapore.
authors: Olivia S
authors: OS
authors: Huang
authors: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Jodhbir S
authors: JS
authors: Mehta
authors: Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.
authors: Hla M
authors: HM
authors: Htoon
authors: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Donald T
authors: DT
authors: Tan
authors: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: tina.wong.t.l@snec.com.sg.
authors: Tina T
authors: TT
authors: Wong
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016039:Corneal Transplantation / Q000009:adverse effects*; D016572:Cyclosporine / Q000009:adverse effects; D003907:Dexamethasone / Q000009:adverse effects; D005260:Female; D005902:Glaucoma, Open-Angle / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D000069605:Olopatadine Hydrochloride / Q000009:adverse effects; D011239:Prednisolone / Q000009:adverse effects / Q000031:analogs & derivatives; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000069605:Olopatadine Hydrochloride; D003907:Dexamethasone; D016572:Cyclosporine; C009935:prednisolone acetate; D011239:Prednisolone