ESCRS - PO0675 - Review Of Glaucoma And Keratoplasty

Review Of Glaucoma And Keratoplasty

Published 2023 - 41st Congress of the ESCRS

Reference: PO0675 | Type: Free paper | DOI: 10.82333/sytn-ek92

Authors: George Liu* 1 , Kessara Pathanapitoon 2 , Napaporn Tananuvat 3 , Christopher Liu 4

1School of Medicine,Anglia Ruskin University,Chelmsford,United Kingdom;School of Medicine,Anglia Ruskin University,Chelmsford,United Kingdom, 2Head of Glaucoma and Uveitis,Chiang Mai University Hospital,Chiang Mai ,Thailand, 3Cornea & Refractive Surgery Unit,Chiang Mai University Hospital,Chiang Mai ,Thailand, 4Tongdean Eye Clinic,Hove,United Kingdom

Purpose

To determine indications and outcomes after optical penetrating keratoplasty (PK)

Setting

Tertiary eye care center in Northern Thailand.

Methods

A retrospective observational study was conducted among patients who underwent PK from January 2006 to December 2019. Patient demographic data, indications for surgery, donor data, and postoperative complications were analyzed. The main outcome measurements were indications for surgery, graft survival rate, and risk factors for failed grafts.

Results

A total of 402 eyes from 402 patients were analyzed. The mean age was 54.4±19.7 (4-95) years, and 60% were men. The median follow-up time was 33.7(6-194) months. Corneal scar (52.5%) was the most common indication for PK followed by bullous keratopathy (24.2%). The graft survival rates were 84%, 61%, 52, and 34% at 1, 3, 5, and 10 years, respectively. Common postoperative complications were increased intraocular pressure (IIOP) or glaucoma (44.3%), allograft rejection (33.6%), anterior synechiae (12.9%), and ocular surface problems (12.2%). The significant risk factors leading to graft failure include aging, preoperative poor visual acuity, postoperative glaucoma or IIOP, allograft rejection, and epitheliopathy.

Conclusions

Corneal scar was the most common indication for PK in Northern Thailand. Graft survival rate was good in the short term. Glaucoma, allograft rejection, and epitheliopathy were common complications and risk factors for graft failure.

 

Tips

  1. Avoid PK unless unavoidable
  2. Avoid very large diameter PKs
  3. Reduce risk of PAS by oversizing donor button
  4. Use HPMC as OVD, remove at end, and cover with IV acetazolamide
  5. Measure IOP every visit
  6. To avoid epithelial downgrowth, don’t ignore leaks and never suture full thickness, suture tightly
  7. Avoid pupil block in EK (DMEK/DSAEK/DSEK) with 80% fill and an inferiorly placed PI
  8. Joint care with glaucoma surgeon
  9. Trabeculectomy should be done with MMC. GDT should aim for PC/sulcus placement and consider the Paul tube