Müller Luzia, Kaufmann Claude, Bachmann Lucas M, Tarantino-Scherrer Janine N, Thiel Michael A, Bochmann Frank
*Department of Ophthalmology, Cantonal Hospital of Lucerne, Lucerne, Switzerland; and †Medignition Inc, Research Consultants, Zurich, Switzerland.
Cornea. 2015 Mar;34(3):271-4. doi: 10.1097/ICO.0000000000000342.
To analyze the occurrence of postoperative intraocular pressure (IOP) elevation and types of pressure-lowering treatment in patients after Descemet stripping automated endothelial keratoplasty (DSAEK) with and without previous diagnoses of glaucoma and/or pseudoexfoliation (PXF) syndrome.
This retrospective assessment considered 211 consecutive DSAEK cases (176 patients) performed by 1 surgeon between January 2007 and November 2010 with at least 1-year follow-up. Salient patient characteristics, IOP, and type of antiglaucoma treatment registered in postoperative visits up to 36 months were extracted from medical records. IOP elevation and its association with glaucoma, PXF, and combination of the 2 were assessed using multivariate ordinal logit models.
Of 211 eyes, 97 eyes (45%) showed at least 1 increase in IOP >25 mm Hg after DSAEK. Of these 97 eyes, 17 eyes (17.5%) had a history of glaucoma alone, another 17 eyes (17.5%) had a history of glaucoma combined with PXF, 10 eyes (9.7%) had PXF alone, and 53 eyes (54.6%) were steroid responders only. To control IOP elevation, steroid reduction alone was performed in 6 eyes (6.2%) and IOP-lowering medication as the only measure was performed in 26 eyes (26.8%). In 46 eyes (47.4%), steroids were reduced in combination with IOP-lowering medication and 16 eyes (16.5%) required surgery. In 3 eyes (3.1%), no action was required. Presence of PXF (odds ratio, 1.71; 95% confidence interval, 0.62-2.81; P = 0.002) and PXF glaucoma (1.14; 95% confidence interval, 0.06-2.21; P = 0.038) required a more intensive IOP-lowering management than patients without PXF with IOP problems.
Increased IOP is common after DSAEK, and a significant number of patients need IOP-lowering treatment. PXF syndrome and PXF glaucoma are risk factors for significant IOP elevation after DSAEK. In most cases, IOP remains controlled with conservative management, but some patients require glaucoma surgery.
分析在接受或未接受过青光眼和/或假性剥脱（PXF）综合征诊断的患者中，Descemet膜剥离自动内皮角膜移植术（DSAEK）后眼内压（IOP）升高的发生率以及降眼压治疗的类型。
这项回顾性评估纳入了2007年1月至2010年11月间由1名外科医生连续实施的211例DSAEK病例（176例患者），随访时间至少为1年。从病历中提取了显著的患者特征、眼压以及术后36个月内随访时记录的抗青光眼治疗类型。使用多变量有序logit模型评估眼压升高及其与青光眼、PXF以及两者合并情况的关联。
在211只眼中，97只眼（45%）在DSAEK后出现至少1次眼压升高>25 mmHg。在这97只眼中，17只眼（17.5%）仅有青光眼病史，另外17只眼（17.5%）有青光眼合并PXF病史，10只眼（9.7%）仅有PXF，53只眼（54.6%）仅是对类固醇有反应者。为控制眼压升高，仅减少类固醇治疗的有6只眼（6.2%），仅采用降眼压药物作为唯一措施的有26只眼（26.8%）。在46只眼（47.4%）中，减少类固醇的同时联合降眼压药物治疗，16只眼（16.5%）需要手术治疗。3只眼（3.1%）无需采取措施。与没有PXF且有眼压问题的患者相比，PXF的存在（优势比，1.71；95%置信区间，0.62 - 2.81；P = 0.002）和PXF青光眼（1.14；95%置信区间，0.06 - 2.21；P = 0.038）需要更强化的降眼压管理。
DSAEK后眼压升高很常见，大量患者需要降眼压治疗。PXF综合征和PXF青光眼是DSAEK后眼压显著升高的危险因素。在大多数情况下，眼压通过保守治疗得以控制，但一些患者需要青光眼手术。
