Sandhu Sartaj, Petsoglou Constantinos, Grigg John, Veillard Anne-Sophie
Departments of *Sydney Eye Hospital †Save Sight Institute, Discipline of Ophthalmology, Sydney Eye Hospital Campus, The University of Sydney ‡National Health and Medical Research Council Clinical trials Centre, University of Sydney, Sydney, Australia.
J Glaucoma. 2016 Apr;25(4):390-6. doi: 10.1097/IJG.0000000000000251.
Our aim was to compare changes in intraocular pressure (IOP) and management of glaucoma in patients undergoing either penetrating keratoplasty (PK) or Descemet stripping endothelial keratoplasty (DSEK).
A retrospective review of all patients who underwent primary corneal transplantation at Sydney Eye Hospital (Sydney, Australia) from January 2008 to December 2010 was performed. Eyes with comparable indications and either primary PK or DSEK with 12 months of follow-up were included. Data on IOP and antiglaucoma management postoperatively were collected. An IOP elevation of ≥30% from baseline or an absolute IOP of >24 at 1 year postoperatively was significant.
Sixty-one eyes from 61 patients met the inclusion criteria. Comparable eyes had undergone either PK (n=28, 46%) or DSEK (n=33, 54%). In patients without prior glaucoma (n=39), 29% of those in the PK group and 28% in the DSEK group required a change in therapy to control IOP (P=0.970). If there was prior glaucoma (n=22), the PK group required a change in 71% of patients compared with the DSEK group, 63% (P=0.665). In both groups of patients, PK and DSEK, elevation of IOP of at least 30% from baseline to 1 year was seen in 39% (P=0.993) regardless of glaucoma status.
Elevation of IOP is a serious consequence of both PK and DSEK, even despite maximal medical therapy in certain cases. DSEK has an equivalent incidence of IOP elevation to PK in comparable patients. Careful monitoring of IOP and appropriate therapy should be instituted to prevent progression to glaucoma.
我们的目的是比较穿透性角膜移植术（PK）或Descemet膜剥离内皮角膜移植术（DSEK）患者的眼压（IOP）变化及青光眼的治疗情况。
对2008年1月至2010年12月在悉尼眼科医院（澳大利亚悉尼）接受初次角膜移植的所有患者进行回顾性研究。纳入具有可比适应证且接受初次PK或DSEK并随访12个月的眼睛。收集术后眼压及抗青光眼治疗的数据。术后1年眼压较基线升高≥30%或绝对眼压>24为有意义。
61例患者的61只眼睛符合纳入标准。可比眼睛分别接受了PK（n = 28，46%）或DSEK（n = 33，54%）。在无青光眼病史的患者中（n = 39），PK组29%的患者和DSEK组28%的患者需要改变治疗方案以控制眼压（P = 0.970）。如果有青光眼病史（n = 22），PK组71%的患者需要改变治疗方案，而DSEK组为63%（P = 0.665）。在PK和DSEK两组患者中，无论青光眼状态如何，从基线到1年眼压至少升高30%的情况在39%的患者中出现（P = 0.993）。
眼压升高是PK和DSEK的严重后果，即使在某些情况下进行了最大程度的药物治疗。在可比患者中，DSEK眼压升高的发生率与PK相当。应仔细监测眼压并进行适当治疗以防止青光眼进展。
