ESCRS - P149 - A COMPARATIVE AND MULTIVARIATE ANALYSIS ON THE LONG-TERM EFFECT ON INTRAOCULAR PRESSURE OF THE PENETRATING KERATOPLASTY VS DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY

A COMPARATIVE AND MULTIVARIATE ANALYSIS ON THE LONG-TERM EFFECT ON INTRAOCULAR PRESSURE OF THE PENETRATING KERATOPLASTY VS DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY

Published 2022 - 26th ESCRS Winter Meeting

Reference: P149 | Type: Abstracts | DOI: 10.82333/hgdt-yz25

Authors: Glenda Espinosa Barberi* 1 , Katia Sotelo-Monge 1 , Jordi Gatell 2 , Laura Pinilla 1 , Antonio Morilla Grasa 3 , Alfonso Anton 1

1Glaucoma and cataracts,ICR,Barcelona,Spain, 2Cornea and cataracts,ICR,Barcelona,Spain, 3Research,ICR,Barcelona,Spain

Purpose

Compare the long-term effect of PK with DSAEK on IOP and to identify the principal risk factors for the development of OHT. 

Setting

In this cross-sectional and multivariate study all consecutive patients which had undergone corneal transplantation at Institut Catalá de Retina between 2008 and 2019 were included.  

Methods

In the present study, 88 eyes from 80 patients were enrolled. Fifty-one eyes undergoing PK, with a mean follow-up of 67.1 ±43.7 months; and thirty-seven undergoing DSAEK, with a mean follow-up of 80.3 ±40.1 months.

The primary outcome measures were IOP change from baseline, number of hypotensive medications required to control IOP, complications and glaucoma procedures needed after corneal surgery. The secondary outcome measures were cumulative failure and rejection rate, change in BCVA and the duration of OHT.

The mean age of patients during surgery was 63.6 ±15.9 years, without significant differences between groups (p= 0.555). 

Results

The most frequent indication for corneal transplantation was bullous keratopathy and it was present in similar frequency in both groups (39.2 % in PK and 40.5% in DSAEK;p=0.89). History of glaucoma was noted in 21 eyes, 9 in the PK group and 12 in the DSAEK. A preoperative diagnosis of OHT was noted in 28 eyes, 15 in the PK group and 13 in the DSAEK group (p=0.141). 

The IOP was significantly higher in the PK group at 1 week (p=0.002), but it value changed considerably trough the months of follow-up. No significant differences in mean IOP were found between group (p>0.05) during other followup visits. Twenty eyes (39.2%) in the PK group and 24 eyes (64.9%) in the DSAEK group developed a significant IOP raise (p=0.018). 

The IOP peak occurred, as a mean, only a few days earlier in DSAEK group than in the PK group (81 ±75.7 days, p= 0.03), and the mean value on increase from baseline was 6.4 mm Hg (p=0.000).

The mean duration of IOP raise significantly longer in PK group (203.8 ±181.3 days) than in  in the DSAEK group (121.9 ±139.7 days; p=0.006). Both groups showed a significant increase in topical hypotensive medication required from baseline values ​​(p>0.05). Both groups showed a significant increase in topical hypotensive medication required from baseline values ​​(p>0.05).

Conclusion

Our study confirmed the relation between history or glaucoma or OHT, previous eye surgery, lens status, punch size and log term topical steroid treatment after surgery and a higher risk for IOP raise. 

In the long term, both groups were equal, although it must be taken into account that in the DSAEK group there was a higher percentage of eyes with glaucoma prior to surgery.  

It should be noted that IOP raise seemed to happened a bit earlier in PK group, but both groups had similar IOP values at one month of follow-up. This is probably because the PK group  undergoes a more aggressive surgery, with more intense  inflammation and a probable remodeling of the irido-corneal angle.