Incidence, Risk Factors and Treatment Outcomes of Intraocular Hypertension and/or Glaucoma Post-Penetrating Keratoplasty: A 5-Year Lebanese Retrospective Descriptive Study.

PURPOSE

Glaucoma is one of the most common complications post-penetrating keratoplasty (PK). In this study, we report the Incidence, risk factors and treatment outcomes of intraocular hypertension (IOH) or/and glaucoma post-penetrating keratoplasty (PKG).

METHODS

A 5-year descriptive retrospective study, Lebanese patients who underwent PK at Beirut Eye & ENT Specialist Hospital, between 2012 and 2017, were included. Patients with history of glaucoma were excluded. IOH/PKG cases that necessitate treatment were identified and analyzed for the incidence, risk factors and treatment outcomes.

RESULTS

A total of 189 eyes of 159 patients were included, with male/female ratio 1.6 and the mean age 47.2±21.3 years. Bullous keratopathy (BK) presented with a high mean age: 70.3 years while ectasia patients were the youngest: 36.5 years. 34.9% of eyes developed high IOP within a mean of 25 months of follow-up distributed between sub-groups of patient with corneal ectasia (22.5%), redo-PK (51.2%), bullous keratopathy (BK) (50%), keratitis (24.9%), and others (dystrophy, trauma …) (21.4%). High IOP developed in 67.4% of the diabetic patients. Visual acuity was less likely to improve in cases developing elevated IOP while postoperative complications were significantly high. In those refractory to medical treatment, trabeculectomy as a glaucoma surgery was effective in lowering the IOP. Combining procedures with PK was not a risk factor for glaucoma. Interrupted sutures and higher number of suturing were associated with increased IOP levels.

CONCLUSION

IOH developed in one out of three patients who underwent penetrating keratoplasty. DM, bullous keratopathy, infectious keratitis and redo-PK were highly associated with PKG, whereas high IOP was less likely to develop in cases with keratoconus. Glaucoma is considered a poor prognostic factor in patients post-PK.