Schirò Roberta, Berger Tim, Munteanu Cristian, Daas Loay, Löw Ursula, Seitz Berthold
Universität des Saarlandes (UdS), Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrbergerstr. 100, 66421, Homburg/Saar, Deutschland.
Ophthalmologie. 2025 Apr 9. doi: 10.1007/s00347-025-02225-7.
Secondary ocular hypertension and glaucoma are severe complications after penetrating keratoplasty (PKP), which increase the risk of graft failure and irreversible loss of vision.
Analysis of intraocular pressure (IOP) elevation in relation to the changes of anterior chamber geometry comparing elective and PKPs à chaud.
This retrospective study at the Department of Ophthalmology, Saarland University Medical Center in Homburg/Saar included 148 eyes after PKP (123 elective and 25 PKPs à chaud). Between 2014 and 2021 treatment data were documented preoperatively and postoperatively after 6-8 weeks, after partial (18 ± 3 months) and after complete (31 ± 6 months) suture removal. The study analyzed visual acuity, IOP, Pentacam® HR (OCULUS GmbH, Wetzlar, Germany) measurements with central and peripheral corneal pachymetry (CCT, PCT), anterior chamber angle (ACA), anterior chamber depth (ACD) and anterior chamber volume (ACV).
The anterior chamber geometry of all eyes changed significantly after PKP: early postoperatively (6-8 weeks) the pachymetry increased (p < 0.001), while ACA, ACD and ACV (p < 0.001) decreased. The average increase of IOP (p < 0.001) showed a positive correlation with CCT and a negative correlation with ACD. In contrast to elective keratoplasty, PKP à chaud revealed significantly lower ACDs and ACVs (p < 0.001) and higher PCTs (nasal p < 0.033, temporal p = 0.042). In contrast, significant differences were not observed for IOP, CCT and ACA. Increases in IOP ≥ 25 mm Hg (n = 21) were more frequent in eyes with keratoconus (n = 14) with a high proportion of these cases showing a steroid response (n = 10).
After PKP the anterior chamber geometry changes postoperatively; however, anterior chamber changes do not necessarily correlate with an increase in IOP. It is possible that a steroid response has a greater influence on postoperative increases in IOP because no significant anterior chamber flattening occurred postoperatively in eyes with keratoconus. In future prospective studies it is expected that further factors with a potential influence will be identified in the complex system of regulation of postoperative IOP.
继发性高眼压和青光眼是穿透性角膜移植术（PKP）后的严重并发症，会增加移植失败和不可逆视力丧失的风险。
比较择期和急诊穿透性角膜移植术，分析眼内压（IOP）升高与前房几何结构变化的关系。
这项在萨尔州大学洪堡/萨尔医学中心眼科进行的回顾性研究纳入了148例接受PKP手术的眼睛（123例择期手术和25例急诊手术）。在2014年至2021年期间，记录了术前以及术后6 - 8周、部分缝线拆除后（18 ± 3个月）和完全缝线拆除后（31 ± 6个月）的治疗数据。该研究分析了视力、IOP、Pentacam® HR（德国韦茨拉尔OCULUS GmbH公司）测量的中央和周边角膜厚度（CCT、PCT）、前房角（ACA）、前房深度（ACD）和前房容积（ACV）。
PKP术后所有眼睛的前房几何结构均发生了显著变化：术后早期（6 - 8周）角膜厚度增加（p < 0.001），而ACA、ACD和ACV降低（p < 0.001）。IOP的平均升高（p < 0.001）与CCT呈正相关，与ACD呈负相关。与择期角膜移植术相比，急诊PKP显示ACD和ACV显著更低（p < 0.001），PCT更高（鼻侧p < 0.033，颞侧p = 0.042）。相比之下，IOP、CCT和ACA未观察到显著差异。IOP升高≥25 mmHg（n = 21）在圆锥角膜患者（n = 14）中更常见，其中这些病例中有很大比例显示出类固醇反应（n = 10）。
PKP术后前房几何结构会发生术后变化；然而，前房变化不一定与IOP升高相关。类固醇反应可能对术后IOP升高有更大影响，因为圆锥角膜患者术后未出现明显的前房变平。在未来的前瞻性研究中，预计将在术后IOP调节的复杂系统中识别出更多具有潜在影响的因素。
