Dr. Lutfi Kirdar Kartal Training and Research Hospital, 1st Eye Clinic, Istanbul, Turkey.
Cornea. 2010 Mar;29(3):278-82. doi: 10.1097/ICO.0b013e3181b6eb9e.
To identify the incidence of and risk factors associated with the development of glaucoma after penetrating keratoplasty.
A retrospective study was carried out between September 1996 and January 2007 with 729 patients' 749 eyes, which underwent penetrating keratoplasty at the 1st Eye Clinic at Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul. Six attending surgeons performed all the surgeries at the same center. Age, sex, preoperative diagnosis, the presence of preoperative glaucoma, the status of the lenses, and additional surgery performed during keratoplasty, which may affect the postoperative intraocular pressure, were evaluated.
The patients' ages ranged from 5 to 86 years (with a mean of 40.9 +/- 20.4 years). Two hundred seventy-seven (61.9%) of the patients were female and 452 (38.1%) were male. Intraocular pressure increases in the early postoperative period occurred in 41 (5.5%) eyes and chronically elevated intraocular pressure was found in 124 (16.6%) eyes. Preoperative diagnosis of inflammatory diseases such as graft thinning (relative risk [RR] = 4.96), traumatic scar formation (RR = 2.66), graft abscess (RR = 2.62), graft rejection (RR = 2.61), bullous keratopathy (RR = 2.59), and corneal abscess (RR = 1.52) were found to be risk factors for the development of glaucoma. Also, the following were significantly associated with an increased risk of glaucoma: peripheral anterior synechia (P = 0.019), preoperative glaucoma (P = 0.0001), and additional surgery combined with penetrating keratoplasty (P = 0.0001). The average period between surgery and the first intraocular pressure elevation was 5.0 +/- 6.5 months for all eyes. The mean intraocular pressure value of eyes that developed glaucoma after penetrating keratoplasty was 27.9 +/- 5.8 mmHg.
Increased intraocular pressure after penetrating keratoplasty is a common clinical problem, and the risk factors are preoperative diagnosis of inflammatory diseases, peripheral anterior synechia, preoperative glaucoma, and additional surgery combined with penetrating keratoplasty.
确定穿透性角膜移植术后青光眼发展的发生率和相关风险因素。
本研究为回顾性研究，对象为 1996 年 9 月至 2007 年 1 月期间在伊斯坦布尔 Dr. Lütfi Kirdar Kartal 培训和研究医院第 1 眼科诊所接受穿透性角膜移植术的 729 例患者的 749 只眼。6 名主治外科医生在同一中心进行了所有手术。评估了年龄、性别、术前诊断、术前青光眼的存在、晶状体状态以及可能影响术后眼内压的角膜移植术中的附加手术。
患者年龄 5-86 岁（平均 40.9 ± 20.4 岁）。277 例（61.9%）为女性，452 例（38.1%）为男性。术后早期眼压升高发生于 41 只眼（5.5%），慢性眼压升高发生于 124 只眼（16.6%）。发现术前诊断为炎症性疾病（如移植物变薄[相对风险（RR）=4.96]、创伤性瘢痕形成[RR=2.66]、移植物脓肿[RR=2.62]、移植物排斥[RR=2.61]、大泡性角膜病变[RR=2.59]和角膜脓肿[RR=1.52]）是青光眼发展的危险因素。此外，以下因素与青光眼风险增加显著相关：周边前粘连（P=0.019）、术前青光眼（P=0.0001）和穿透性角膜移植术联合附加手术（P=0.0001）。所有眼术后至首次眼压升高的平均时间为 5.0 ± 6.5 个月。穿透性角膜移植术后发生青光眼的眼平均眼压值为 27.9 ± 5.8mmHg。
穿透性角膜移植术后眼压升高是常见的临床问题，危险因素包括术前炎症性疾病诊断、周边前粘连、术前青光眼和穿透性角膜移植术联合附加手术。
