Patyal Sagarika, Banarji Ajay, Gurunadh V S, Bhadauria Madhu, Kumar Poninder, Upadhyay A K
Assoc Prof, Department of Ophthalmology, AFMC, Pune - 40.
Consultant, CH (EC) Kolkata.
Med J Armed Forces India. 2011 Apr;67(2):113-6. doi: 10.1016/S0377-1237(11)60007-5. Epub 2011 Jul 21.
Glaucoma can develop after penetrating keratoplasty resulting in irreversible loss of vision. The incidence of post-penetrating keratoplasty glaucoma varies from 31% in the early postoperative period to 29% after three months. Various factors are responsible for the rise of intraocular pressure (IOP). This study was carried out to evaluate the effect of 0.5 mm larger donor corneal size on IOP following penetrating keratoplasty.
Patients were divided into two groups: group I was phakic and group II consisted of aphakic and pseudophakic patients. The same surgical technique was used for obtaining and suturing the donor graft. The viscoelastics and the postoperative regime also remained the same in all cases. IOP was measured by the rebound tonometer.
The incidence of postoperative raised IOP in the first seven days in the phakic group was found to range from 16 mmHg to 25 mmHg and IOP in the aphakic/pseudophakic group ranged from 16 mmHg to 42 mmHg. The IOP in the phakic group after three weeks of surgery was around 12.3 mmHg and that in the pseudophakic/aphakic group was 14.8 mmHg-16.2 mmHg. In aphakic patients, IOP was controlled in the first six months with eyedrops Timolol 0.5% and tablet acetazolamide which was given only for short periods. IOP settled to < 12 mmHg with timolol 0.5% after six months. In the pseudophakic patients, IOP became normal by six months. These were inclusive of patients who had undergone anterior reconstruction and/or vitrectomy.
The study proves that keeping the donor corneal size 0.5 mm larger does not affect IOP and that aphakia itself is a factor responsible for rise of IOP due to anterior chamber angle compression.
穿透性角膜移植术后可发生青光眼，导致不可逆转的视力丧失。穿透性角膜移植术后青光眼的发生率在术后早期为31%，三个月后为29%。眼内压（IOP）升高由多种因素引起。本研究旨在评估供体角膜尺寸增大0.5mm对穿透性角膜移植术后眼压的影响。
患者分为两组：第一组为有晶状体眼，第二组包括无晶状体眼和人工晶状体眼患者。获取和缝合供体移植物采用相同的手术技术。所有病例中粘弹性物质和术后治疗方案也保持相同。通过回弹眼压计测量眼压。
有晶状体眼组术后前七天眼压升高范围为16mmHg至25mmHg，无晶状体眼/人工晶状体眼组眼压范围为16mmHg至42mmHg。手术三周后有晶状体眼组眼压约为12.3mmHg，人工晶状体眼/无晶状体眼组眼压为14.8mmHg - 16.2mmHg。对于无晶状体眼患者，最初六个月使用0.5%噻吗洛尔滴眼液和仅短期使用的乙酰唑胺片控制眼压。六个月后使用0.5%噻吗洛尔眼压降至<12mmHg。对于人工晶状体眼患者，六个月时眼压恢复正常。这些患者包括接受过前部重建和/或玻璃体切除术的患者。
该研究证明供体角膜尺寸增大0.5mm不影响眼压，并且无晶状体眼本身是由于前房角受压导致眼压升高的一个因素。
