Rumelt Shimon, Bersudsky Valery, Blum-Hareuveni Tami, Rehany Uri
Department of Ophthalmology, Western Galilee-Nahariya Medical Center, Nahariya, Israel.
Cornea. 2002 Nov;21(8):759-65. doi: 10.1097/00003226-200211000-00005.
To evaluate the incidence, risk factors, management, and visual outcome of postoperative glaucoma in comparison with preexisting glaucoma in repeated corneal transplantation.
The charts of all the patients who underwent repeated corneal transplantation between 1985 and 1998 were reviewed for the occurrence of preexisting and postoperative glaucoma. Eighty patients underwent 122 repeated corneal transplantations, of which six underwent surgery in both eyes. The mean follow-up period from the primary keratoplasty was 89.5 months and the minimal follow-up period was at least 6 months after the last transplantation.
Postoperative glaucoma affected 29 eyes (34%) in 28 patients (35%) with repeated corneal transplantation. Herpetic scar as an indication for transplantation and a history of previous immune graft rejection were more common in patients who developed postoperative glaucoma compared with the entire regrafted group ( p= 0.016 and p< 0.001, respectively). The incidence of glaucoma usually increased with the increased number of keratoplasties. The following types of glaucoma were disclosed: closed angle (59%), corticosteroid induced (21%), open angle (11%), angle recession (3%), aqueous misdirection (3%), and unknown cause (3%). Surgical intervention was required in 62%. Glaucoma was controlled in nine eyes (31%) and resolved following regrafting or discontinuation of corticosteroids in four eyes (14%), of which five (17%) had clear regrafts. Better intraocular pressure control was achieved in those cases that did not require surgical intervention ( p= 0.019). In 15 eyes (52%), regrafts failed due to uncontrolled glaucoma and/or other causes. At the end of the follow-up period, visual acuity was 20/30 to 20/200 in 17%, counting fingers from less than 20 ft in 31%, hand movement/light perception in 35%, and no light perception in 17%. Six of the 86 eyes (7%) in six patients (7.5%) had preexisting glaucoma. Graft clarity and glaucoma control in patients with preexisting glaucoma were similar to those of postkeratoplasty glaucoma (50% had controlled glaucoma and 33% had clear regraft).
Glaucoma, either preexisting or postoperative, is one of the most devastating complications of repeated corneal transplantation and the cause for regraft failure and visual loss even when intensively treated. Close monitoring and early targeted therapy are warranted to increase the survival of repeated corneal transplants in eyes affected by glaucoma.
评估再次角膜移植术后青光眼的发生率、危险因素、治疗方法及视力预后，并与术前已存在的青光眼进行比较。
回顾1985年至1998年间所有接受再次角膜移植患者的病历，以了解术前及术后青光眼的发生情况。80例患者接受了122次再次角膜移植，其中6例患者双眼均接受了手术。从首次角膜移植术开始的平均随访时间为89.5个月，最短随访时间为最后一次移植术后至少6个月。
再次角膜移植的28例患者（35%）中的29只眼（34%）发生了术后青光眼。与整个再次移植组相比，因疱疹性瘢痕而进行移植以及既往有免疫移植排斥史在发生术后青光眼的患者中更为常见（分别为p = 0.016和p < 0.001）。青光眼的发生率通常随着角膜移植次数的增加而升高。发现了以下几种类型的青光眼：闭角型（59%）、皮质类固醇性（21%）、开角型（11%）、房角后退型（3%）、房水错流型（3%）和病因不明型（3%）。62%的患者需要手术干预。9只眼（31%）的青光眼得到控制，4只眼（14%）在再次移植或停用皮质类固醇后青光眼得到缓解，其中5只眼（17%）再次移植成功。在那些不需要手术干预的病例中，眼压控制得更好（p = 0.019）。15只眼（52%）因青光眼未得到控制和/或其他原因再次移植失败。在随访期末，视力为20/30至20/200的患者占17%，在距离小于20英尺处数指的患者占31%，手动/光感的患者占35%，无光感的患者占17%。6例患者（7.5%）的86只眼中有6只（7%）术前已存在青光眼。术前已存在青光眼患者的植片透明度和青光眼控制情况与角膜移植术后青光眼患者相似（50%的患者青光眼得到控制，33%的患者再次移植成功）。
术前或术后青光眼是再次角膜移植最严重的并发症之一，即使经过积极治疗，也是再次移植失败和视力丧失的原因。对于受青光眼影响的眼睛，有必要进行密切监测并尽早进行针对性治疗，以提高再次角膜移植的成功率。
