Haddadin Ramez I, Chodosh James
Massachusetts Eye & Ear Infirmary, Ophthalmology, Cornea & Refractive Surgery Service, Harvard Medical School , Boston, Massachusetts , USA.
Semin Ophthalmol. 2014 Sep-Nov;29(5-6):380-96. doi: 10.3109/08820538.2014.959201.
Glaucoma is the leading cause of irreversible vision loss post-keratoplasty and an important cause of graft failure. With newer techniques, such as lamellar, endothelial, and laser-assisted keratoplasty as well as keratoprosthesis gaining popularity, clinicians will need to consider the incidence, risks, evaluation, and management of glaucoma for each type of keratoplasty when determining which type of transplant may be most appropriate. A comprehensive literature search of glaucoma in the setting of corneal transplantation was performed and serves as the basis for this review. Preexisting glaucoma and aphakia are notable risk factors. Patients that are candidates for deep anterior lamellar keratoplasty may benefit from reduced rates of post-keratoplasty glaucoma. Although glaucoma also complicates eyes with Descemet stripping endothelial keratoplasty, the severity is less and the intraocular pressure is more easily controlled when compared to penetrating keratoplasty. Endothelial keratoplasty creates unique perioperative issues mostly related to management of anterior chamber air bubbles.
青光眼是角膜移植术后不可逆视力丧失的主要原因,也是移植失败的重要原因。随着板层角膜移植、内皮角膜移植、激光辅助角膜移植以及角膜假体等新技术越来越受欢迎,临床医生在确定哪种移植类型可能最合适时,需要考虑每种角膜移植类型的青光眼发病率、风险、评估和管理。我们对角膜移植背景下的青光眼进行了全面的文献检索,并以此作为本综述的基础。既往存在的青光眼和无晶状体是显著的危险因素。适合进行深板层角膜移植的患者可能会受益于角膜移植术后青光眼发生率的降低。虽然青光眼也会使接受Descemet膜剥除内皮角膜移植的眼睛出现并发症,但与穿透性角膜移植相比,其严重程度较轻,眼压更容易控制。内皮角膜移植会产生独特的围手术期问题,主要与前房气泡的管理有关。