Elalfy Mohamed, Maqsood Sundas, Soliman Shady, Hegazy Sherif Momtaz, Hannon Ahmed Abdou, Gatzioufas Zisis, Lake Damian, Hamada Samer
Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.
Eye Department, Maidstone and Turnbridge Wells Hospital, Maidstone, UK.
Clin Ophthalmol. 2021 May 25;15:2179-2188. doi: 10.2147/OPTH.S299098. eCollection 2021.
To evaluate the incidence, demographics, associated risk factors, management and clinical outcomes of ocular hypertension/glaucoma after Descemet stripping automated endothelial keratoplasty (DSAEK).
A cohort review of 81 DSAEK cases was performed at Queen Victoria Hospital, United Kingdom. Patients with pre-existing glaucoma, transient increased IOP within the first 48 hours post-graft, additional post-transplant surgery, or failed to complete one year follow-up were excluded from the study. Ocular hypertension was defined as intraocular pressure (IOP) elevation >21mmHg or ≥6mmHg from baseline at any postoperative visit. The study looked at the incidence, risk factors, response to anti-glaucoma treatment, graft failure and best corrected visual acuity.
The incidence of post-DSAEK ocular hypertension and glaucoma was 51.9% and 13.6%, respectively. Steroid-induced IOP elevation was the most frequent cause, with an incidence of 38.3%. Risk factors such as pseudophakia (p=0.024) and preoperative IOP>16 (p=0.003) were found to be associated with post-DSAEK ocular hypertension. Preoperative IOP>16 had 5.27 times risk of IOP elevation. Eyes with graft dislocation and/or detachment were significantly associated with post-DSAEK glaucoma (p=0.038). There was no negative effect of OHT on visual acuity and graft status.
Glaucoma and OHT are common postoperative complications of DSAEK. Although steroid-induced IOP elevation was the most frequent cause, there are other reasons associated with development of post-DSAEK glaucoma, including graft dislocation and detachment. Eyes with preoperative IOP>16 mm Hg may require a close monitoring of IOP. In addition, management by medical treatment results in good visual acuity and graft clarity.
评估深板层角膜内皮移植术（DSAEK）后高眼压/青光眼的发生率、人口统计学特征、相关危险因素、治疗方法及临床结局。
在英国维多利亚女王医院对81例DSAEK病例进行队列研究。排除术前已患青光眼、移植术后48小时内眼压短暂升高、术后进行其他手术或未完成一年随访的患者。高眼压定义为术后任何一次随访时眼压升高>21mmHg或较基线升高≥6mmHg。该研究观察了高眼压和青光眼的发生率、危险因素、抗青光眼治疗反应、植片失败情况及最佳矫正视力。
DSAEK术后高眼压和青光眼的发生率分别为51.9%和13.6%。激素性眼压升高是最常见原因，发生率为38.3%。发现诸如人工晶状体眼（p = 0.024）和术前眼压>16（p = 0.003）等危险因素与DSAEK术后高眼压相关。术前眼压>16时眼压升高风险为5.27倍。植片脱位和/或脱离的眼与DSAEK术后青光眼显著相关（p = 0.038）。高眼压对视力和植片状态无负面影响。
青光眼和高眼压是DSAEK常见的术后并发症。虽然激素性眼压升高是最常见原因，但DSAEK术后青光眼的发生还有其他原因，包括植片脱位和脱离。术前眼压>16mmHg的眼可能需要密切监测眼压。此外，药物治疗可保持良好视力和植片清晰度。
