Sihota R, Sharma N, Panda A, Aggarwal H C, Singh R
Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.
Aust N Z J Ophthalmol. 1998 Nov;26(4):305-9. doi: 10.1111/j.1442-9071.1998.tb01334.x.
To evaluate the incidence, associated risk factors, graft status and treatment modalities in patients with post-penetrating keratoplasty glaucoma.
A retrospective analysis of 747 consecutive penetrating keratoplasties was undertaken at a tertiary eye care centre. The frequency of post-penetrating keratoplasty glaucoma was determined and correlated with the pre-operative corneal diagnosis, lens status and associated surgeries performed during penetrating keratoplasty. The response to antiglaucoma therapy (i.e. medical, surgical or cyclo-destructive procedures) and graft outcome was also evaluated.
The incidence of post-penetrating keratoplasty glaucoma was 10.6% (79/747). Pre-operative corneal diagnosis of adherent leucomas was significantly associated with the development of postoperative glaucoma. Post-penetrating keratoplasty glaucoma was significantly higher in aphakes (odds ratio (OR) 6.6; confidence interval (CI) 3.81-11.69) compared with phakic or pseudophakic eyes. Associated vitrectomy (OR 2.32; CI 1.16-4.73) and anterior segment reconstruction (OR 3.31; CI 1.43-7.72) were other high-risk factors. Most patients responded to medical therapy (41/79; 51.9%), whereas filtering surgery and cyclo-destructive procedures were performed in 29.1 (23/79) and 19% (15/79) of eyes, respectively. Despite clear grafts in 39 eyes (49.4%), visual acuity of 6/18 or better was achieved in 15 eyes (18.9%).
A high incidence of post-penetrating keratoplasty glaucoma occurs in eyes with adherent leucomas. Anterior vitrectomy and associated surgeries further accentuate the risk Anti-glaucoma therapy may not achieve optimum visual outcome, despite a clear graft.
评估穿透性角膜移植术后青光眼患者的发病率、相关危险因素、植片状态及治疗方式。
在一家三级眼科护理中心对747例连续穿透性角膜移植术进行回顾性分析。确定穿透性角膜移植术后青光眼的发生率，并将其与术前角膜诊断、晶状体状态及穿透性角膜移植术中进行的相关手术相关联。还评估了抗青光眼治疗（即药物、手术或睫状体破坏手术）的反应及植片结果。
穿透性角膜移植术后青光眼的发生率为10.6%（79/747）。术前角膜诊断为粘连性角膜白斑与术后青光眼的发生显著相关。与有晶状体或人工晶状体眼相比，无晶状体眼中穿透性角膜移植术后青光眼的发生率显著更高（优势比（OR）6.6；置信区间（CI）3.81 - 11.69）。相关的玻璃体切除术（OR 2.32；CI 1.16 - 4.73）和前段重建术（OR 3.31；CI 1.43 - 7.72）是其他高危因素。大多数患者对药物治疗有反应（41/79；51.9%），而分别有29.1%（23/79）和19%（15/79）的眼睛接受了滤过手术和睫状体破坏手术。尽管39只眼（49.4%）的植片透明，但15只眼（18.9%）的视力达到了6/18或更好。
粘连性角膜白斑患者穿透性角膜移植术后青光眼的发生率较高。前部玻璃体切除术及相关手术会进一步增加风险。尽管植片透明，但抗青光眼治疗可能无法达到最佳视力结果。
