Glaucoma and Penetrating Keratoplasty : Incidence, Risk Factors, and Outcomes Sonika Gupta Consultant Ophthalmology Max Eye Care New Delhi, India Author.

Glaucoma and Penetrating Keratoplasty : Incidence, Risk

Factors, and Outcomes

Sonika GuptaConsultant Ophthalmology

Max Eye CareNew Delhi, India

Author has no financial interest

Purpose of the study To evaluate the incidence, risk factors, treatment

modalities, graft status and visual acuity outcome in patients with post - Penetrating Keratoplasty (PK) glaucoma.

Materials and Methods Retrospective analysis of 260 eyes of 260 consecutive

patients who had undergone PK between 2004 and 2008 was carried out and medical records of patients diagnosed with post-PK glaucoma were reviewed.

Materials and Methods

Medical records were reviewed for Age Sex Indication for PK Preoperative visual acuity Evidence of preexisting glaucoma Use of antiglaucoma medications and

surgeries performed

Materials and methodsIntraoperative data included Details of surgical procedure including type of

surgery and graft size. Whether combined with cataract surgery, intraocular

lens removal, intraocular lens exchange, secondary IOL implantation, anterior vitrectomy

Materials and methods Follow up information Post operative visual acuity Status of corneal graft Status of anterior chamber IOP (as measured by Goldmann applanation

tonometer) Disc evaluation in cases where media was

clear Type of management: medical therapy,

glaucoma filtering surgery, cyclocryotherapy. Final visual outcome and status of graft

Results Total no. of eyes which had undergone PK- 260 eyes

(of 260 patients) Incidence of post PK glaucoma - 11.54% (30/260

eyes) Age range- 8-76 years 20 males , 10 females Mean follow up period -15 months

Indications for PK

26%

20%20%

17%

10%7%

Adherentleucoma

Perforatedcorneal ulcer

Aphakic bullouskeratopathy

Infectivekeratitis

Failed graft

PBK

Results

Aphakia was seen in 13 eyes (43.3%) Additional surgical procedures done in 7 eyes

(23.3%) : cataract surgery in 4, anterior vitrectomy in 3 eyes.

Pre-existing glaucoma in 6 eyes (20%) out of which 4 eyes had previous glaucoma filtering surgery.

Mean graft size was 8.03 mm.

Treatment modalities

18

7

4

102468

1012141618

no.of cases

Treatmentmodalities

MedicalTherapy

Trabeculectomy + MMC

Cyclodestructive procedures

Vitreousaspiration +airinjection

Outcome Clear graft seen in 15 eyes (50%) Vision of 20/200 or better in 8 eyes (26.6%) Aphakia (odds ratio OR 9.71) and associated surgical

procedures (OR 2.18) were significant risk factors

Fig 1: clear graft in post-PKglaucoma treated with medical therapy

Fig.2: Failed vascularized graftin post-PK glaucoma. IOP controlledwith cyclocryotherapy

Conclusion Uncontrolled IOP after PK is one of the leading

causes of graft failure and visual loss Despite clear grafts, optimal visual outcome may

not be obtained It is mandatory to monitor IOP on a regular basis

after corneal transplantation and aggressively treated if found high.