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Session Title: Cornea surgical I
Session Date/Time: Tuesday 08/10/2013 | 08:00-10:30
Paper Time: 10:06
Venue: Forum (Ground Floor)
First Author: : O.Oganesyan RUSSIA
Co Author(s): : V. Neroev R. Gundorova
Glaucoma is one of the most serious complications after keratoplasty because of its high incidence, severity and the difficulty in its diagnosis and treatment. Postkeratoplasty glaucoma is the one of the leading cause of graft failure. The incidence of glaucoma after keratoplasty has been shown to range from 10% to 53% for all eyes undergoing penetrating keratoplasty(PKP). The modern technique of endothelial keratoplasty (EK) eliminates some risk factors of postPKP glaucoma - corneal sutures, aphakia, changes a depth of anterior chamber. It is reasonable to assume that EK might be associated with a lower rate of postoperative glaucoma than PKP. The aim of this study is to evaluate the frequency of glaucoma (included steroid induced) in patients after Descemet`s membrane endothelial keratoplasty (DMEK).
The Helmholtz Moscow Research Institute of Eye Diseases
Retrospective review of every case of DMEK is performed between January 2008 and January 2012. Follow-up is ranged from 12 to 48 months (mean 27.1± 12.6). After DMEK all patients instilled corticosteroid drops as follows: 1 week -5 times a day, 1 week - 4 times a day, 6 weeks to 3 times a day, 2 months - 2 times a day, 2 months - 1 per day, 2 months - 1 per day every other day, 2 months - 2 times a week. All the patients included in the study had normal intraocular pressure (IOP) before undergoing keratoplasty, including patients with preexisting glaucoma. IOP measurements were recorded preoperatively; postoperative first month 3 months, 6 months and every 6 month. When pressure rises above 24 mm Hg, the visual field and HRT study was performed.
38 eyes with pseudophakic bullous keratopathy (PBK) and 51 eyes with Fuchs dystrophy were included in this study. A total 100 DMEK was performed of 78 patients (89 eyes). The mean age was 65.9 years. Before DMEK compensated glaucoma was occurred in 15 eyes, among which 11 eyes underwent surgery for glaucoma (before DMEK). The average age of the all patients was 70.8 years. In 5 eyes (33%) EK was performed repeatedly. At 6 eyes was Fuchs dystrophy, in 9 eyes was PBK. At follow-up increase the IOP (after cessation of steroid therapy) occurred in 5 of 15 eyes with preexisting glaucoma (30%). In 3 cases of them, IOP was compensated by additional topical medical therapy, in 2 cases was performed sinustrabeculectomy. In the group of patients without preexisting glaucoma secondary glaucoma cases were not found during the follow-up.
Post DMEK glaucoma is unusual with above mentioned schema of steroid therapy. Preexisting glaucoma is a significant risk factor for increasing the IOP after DMEK.
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