印度三级医疗中心角膜移植术后青光眼的发病率及危险因素

Incidence and risk factors for postkeratoplasty glaucoma in tertiary care center, India.

作者信息

Raj Anuradha, Dhasmana Renu, Bahadur Harsh

机构信息

Department of Ophthalmology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India.

出版信息

Oman J Ophthalmol. 2018 Sep-Dec;11(3):220-226. doi: 10.4103/ojo.OJO_159_2017.

DOI:10.4103/ojo.OJO_159_2017

PMID:30505111

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6219344/

Abstract

BACKGROUND

Glaucoma is the leading cause of blindness after penetrating keratoplasty (PK) and its early diagnosis and management is mandatory to salvage the graft.

AIMS

This study aimed to evaluate the incidence and risk factors for post penetrating keratoplasty glaucoma (PKG).

METHODS

Data of 155 eyes of 155 patients were reviewed retrospectively who underwent PK from March 2013 to February 2016. Data were analyzed from recipient records for recipient age, sex, indications, type of PK, lens status, recipient graft size or any additional procedure. Detailed ophthalmological examination was recorded for all cases including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP) by applanation tonometry or tonopen, central corneal thickness (CCT) and gonioscopy. IOP measurement records were reviewed at each visit of one week, two weeks,one, three and six months and if IOP was elevated (>22 mmHg) medical management was initiated. Uncontrolled IOP with antiglaucoma medication (AGM) required surgical management.

RESULTS

Overall incidence of raised IOP after PK was 32.25%. Increase in IOP post PK was reported mainly in 32 (64%) among age group >40 years. Raised IOP showed significant association with age group, indications of PK, recipient size and CCT ( value 0.00, 0.01, 0.00, 0.00) respectively. Two weeks after PK 46 (29.67%) patients reported an increase in IOP ,47(30.32 %) after 1 months, 33 (21.29%) at 3 months and 30 (19.35%) at 6 months. In 11 (39.28%) cases cataract was major long term complication seen in PKG cases. 35 (70%) cases of PKG were treated medically and 15 (30%) patients required surgical treatment.

CONCLUSION

Subjects with age group >40 years, corneal opacity, increased recepient size and increased CCT are risk factors for PKG. IOP monitoring in early post operative period especially one month after PK is mandatory to avoid graft failure due to PKG which is difficult to diagnose otherwise.

摘要

背景

青光眼是穿透性角膜移植术（PK）后导致失明的主要原因，其早期诊断和治疗对于挽救移植片至关重要。

目的

本研究旨在评估穿透性角膜移植术后青光眼（PKG）的发生率及危险因素。

方法

回顾性分析2013年3月至2016年2月期间接受PK的155例患者的155只眼的数据。从受者记录中分析受者年龄、性别、适应证、PK类型、晶状体状态、受者移植片大小或任何附加手术等数据。记录所有病例的详细眼科检查结果，包括最佳矫正视力（BCVA）、裂隙灯检查、应用压平眼压计或眼压笔测量眼压（IOP）、中央角膜厚度（CCT）和前房角镜检查。在术后1周、2周、1个月、3个月和6个月的每次随访时复查IOP测量记录，若IOP升高（>22 mmHg）则开始药物治疗。使用抗青光眼药物（AGM）无法控制的IOP需要手术治疗。

结果

PK术后IOP升高的总体发生率为32.25%。PK术后IOP升高主要见于年龄>40岁的患者中的32例（64%）。IOP升高分别与年龄组、PK适应证、受者大小和CCT显著相关（P值分别为0.00、0.01、0.00、0.00）。PK术后2周，46例（29.67%）患者报告IOP升高，1个月后为47例（30.32%），3个月时为33例（21.29%），6个月时为30例（19.35%）。在PKG病例中，11例（39.28%）白内障是主要的长期并发症。35例（70%）PKG病例接受了药物治疗，15例（30%）患者需要手术治疗。