Glaucoma after Penetrating Keratoplasty: Incidence, Risk Factors, and Management (original) (raw)
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Post penetrating keratoplasty glaucoma - A review
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH, 2014
Glaucoma following penetrating keratoplasty remains a challenge for the treating ophthalmologist. Its frequent occurrence, difficult diagnosis and recalcitrant nature coupled with the propensity to cause irreversible visual loss makes it essential to identify the problem early and manage it effectively. A careful pre-operative assessment along with appropriate intra-operative measures can help to reduce the chances of developing glaucoma in the post-operative period. Wherever indicated, prompt therapy should be initiated to lower intraocular pressure and salvage vision. Effective management of post-operative keratoplasty glaucoma remains an enigma with no single therapy being suited for all cases. One has to weigh the risks and benefits of the anti-glaucoma drugs on the corneal graft. However, it should be kept in mind that although there is a potential option for a graft exchange, vision lost from glaucomatous optic nerve damage cannot be recovered. This review aims at highlighting...
Glaucoma after penetrating keratoplasty: Risk factors and its management
IP innovative publication pvt. ltd, 2019
Abstract Glaucoma is the second leading cause of graft failure after penetrating keratoplasty. Prompt diagnosis and aggressive management is mandatory to salvage the graft. Indications of penetrating keratoplasty, lens status, additional procedures with penetrating keratoplasty, preexisting glaucoma and re-graft are the main risk factors for glaucoma after penetrating keratoplasty. Various newer modalities like recent tonopens, ultrasound biomicroscopy, and anterior segment optic coherence tomography are helpful tools for its diagnosis. Various newer drugs, surgical modifications such as trabeculectomy with antimetabolites like mitomycin-C and 5 fluorouracil, glaucoma drainage devices, cyclodestructive procedures have added the chances of success of its management, but still graft failure secondary to glaucoma is very common. Keywords: Trabeculectomy, Glaucoma drainage device, Graft failure.
Post-penetrating keratoplasty glaucoma
Indian Journal of Ophthalmology, 2008
Post-penetrating keratoplasty (post-PK) glaucoma is an important cause of irreversible visual loss and graft failure. The etiology for this disorder is multifactorial, and with the use of new diagnostic equipment, it is now possible to elucidate the exact pathophysiology of this condition. A clear understanding of the various mechanisms that operate during diff erent time frames following PK is essential to chalk out the appropriate management algorithms. The various issues with regard to its management, including the putative risk factors, intraocular pressure (IOP) assessment post-PK, diffi culties in monitoring with regard to the visual Þ elds and optic nerve evaluation, are discussed. A step-wise approach to management starting from the medical management to surgery with and without metabolites and the various cycloablative procedures in cases of failed Þ ltering procedures and excessive perilimbal scarring is presented. Finally, the important issue of minimizing the incidence of glaucoma following PK, especially through the use of oversized graft s and iris tightening procedures in the form of concomitant iridoplasty are emphasized. It is important to weigh the risk-beneÞ t ratio of any modality used in the treatment of this condition as procedures aimed at IOP reduction, namely trabeculectomy with antimetabolites, and glaucoma drainage devices can trigger graft rejection, whereas cyclodestructive procedures can not only cause graft failure but also precipitate phthisis bulbi. Watchful expectancy and optimal time of intervention can salvage both graft and vision in this challenging condition.
Glaucoma Post-Penetrating Keratoplasty Glaucoma
2014
I TXKPG CPF-CWHOCP YGTG VJG ſTUV VQ FGUETKDG CP association between penetrating keratoplasty (PK) and glaucoma 1. Post-penetrating keratoplasty glaucoma (PPKG) is one of the most challenging problems because of its HTGSWGPV QEEWTTGPEG FKHſEWNV FKCIPQUKU TGECNEKVTCPV PCVWTG irreversible visual loss due to damage to optic nerve as well CU VJG FQPQT GPFQVJGNKWO CPF OCPCIGOGPV FKHſEWNV[ Definition 2QUV2-INCWEQOC KU FGſPGF CU CP GNGXCVGF KPVTCQEWNCT RTGUUWTG +12 ITGCVGT VJCP OO*I YKVJ QT YKVJQWV CUUQEKCVGF XKUWCN ſGNF NQUU QT QRVKE PGTXG JGCF EJCPIGU CV any time during the post operative period.
Eye, 1988
The incidence of post-keratoplasty glaucoma remains at about 30% of all grafts performed. Aphakic eyes, particularly those after intracapsular extraction, the elderly, traumatised eyes and eyes undergoing repeat corneal grafts appear to be at greatest risk. This paper also reviews the mechanisms and treatment of post keratoplasty glaucoma.
Surgical Management for Postkeratoplasty Glaucoma
Journal of Glaucoma, 2014
Purpose: To perform a meta-analysis on postkeratoplasty glaucoma and directly compare the affect of trabeculectomy, cyclophotocoagulation (CPC), and glaucoma drainage device (GDD) on intraocular pressure (IOP) control and corneal graft survival. Methods: We searched Medline (Ovid, PubMed), EMBASE, and The Cochrane Library databases for clinical articles that maintained our inclusion criteria. The primary outcome measures were IOP control and overall corneal graft survival. The secondary outcomes were failure rate of the primary glaucoma procedure and change in visual acuity. We used 1-way analysis of variance weighed by the number of participants in each study to compare the outcomes. Results: Information from a total of 266 eyes was collected from 13 articles. Trabeculectomy reduced IOP by 13.6 mm Hg compared with 20.4 mm Hg with CPC and 20.2 mm Hg with GDD (P < 0.001). The failure rate of glaucoma surgery was highest after trabeculectomy 37% (95% CI, 31.4%-41.9%) compared with 20.7% (95% CI, 17.6%-23.7%) after CPC and 16% (95% CI, 13.8%-18.9%) after GDD and this was statistically significant (P < 0.001). GDD was associated with higher rate of corneal graft failure (35%) than either CPC or trabeculectomy (21% and 24%, P = 0.001 and P < 0.001, respectively). The percentage of patients who experienced worsening of vision was the highest after CPC (26%) and the least with GDD (20%). Conclusions: Our meta-analysis shows that in patients with postkeratoplasty glaucoma, GDD is associated with greater IOP control, the lowest glaucoma surgery failure rate, and less vision loss compared with other forms of glaucoma surgery. However, GDD surgery is also associated with higher rate of graft failure.
Penetrating keratoplasty and glaucoma
Survey of ophthalmology, 2000
Many complications can occur after penetrating keratoplasty. Allograft rejection leading to graft failure and severe graft astigmatism not amenable to contact lens fitting are major problems. These complications, however, do not limit the visual potential of the eye. On the other ...