Incidence and Risk Factors of Elevated Intraocular Pressure Following Deep Anterior Lamellar Keratoplasty

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• 作者：Olivia S. Huang^a ; Jodhbir S. Mehta^a ; ^b ; ^c ; ^d ; Hla M. Htoon^b ; ^c ; Donald T. Tan^a ; ^b ; ^c ; ^d ; Tina T. Wong^a ; ^b ; ^c ; ^d ; ^{tina.wong.t.l@snec.com.sg" class="auth_mail" title="E-mail the corresponding author}
• 刊名：American Journal of Ophthalmology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：170
• 期：Complete
• 页码：153-160
• 全文大小：289 K

文摘

To report the incidence and risk factors of elevated IOP following deep anterior lamellar keratoplasty (DALK).

Design

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.