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The relationship between post-penetrating keratoplasties (PPK) and intra-ocular pressure (IOP)

Poster Details

First Author: M.Jain UK

Co Author(s):    N. Din   K. Williams   L. Ficker              

Abstract Details


Glaucoma is the leading cause of irreversible vision loss post-keratoplasty and an important cause of graft failure. Whilst other surgical techniques are available and gaining popularity, such as lamellar keratoplasties, endolamellar keratoplasties or laser-assisted keratoplasties, penetrating keratoplasties are still an important tool in a corneal surgeon’s armamentarium . This study looks into the incidence of high IOP following keratoplasty and some of the associated risk factors, including the proportions of patients requiring glaucoma interventions.


Moorfields Eye Hospital, Cornea and External diseases department


A retrospective observational study was performed identifying all penetrating keratoplasties (PK) performed over a one year. We identified 101 individuals who underwent a PK. Surgery was performed on a range of underlying aetiologies: keratoconus (n=43), microbial keratitis (n=16), perforation and trauma (n=5), re-do corneal grafts (n=7). Other aetiologies included aniridia (n=2), glaucoma with drainage tubes (n=6), herpes simplex keratitis (n=5). Surgery was performed in combination with cataract surgery in six cases, amniotic membrane grafting in two cases, an anterior vitrecotmy in one case, an iris biopsy in one case and converted from a DALK in two cases.


At baseline the mean IOP was 11mHg (range 3-29 mmHg). Pre-existing ocular hypertension and glaucoma was noted in one and eighteen cases respectively, with five individuals having a glaucoma drainage device in situ. Following PK an IOP spike ≥ 22 mmHg was noted in 24.8% of cases (n=25), of which 6 had pre-existing glaucoma. An IOP spike ≥ 30 mmHg was noted in 6.9% of cases, of which 2 had pre-existing glaucoma. Treatments for raised IOP included topical anti-hypertensives alone, cyclodiode and surgery .


We identified a relatively high incidence of IOP spikes following PK. Identifying risk factors permits close follow-up and timely treatment of any postoperative IOP rises. It appears the pre-existing glaucoma was common, and this should be carefully sought and appropriately treated prior to PK.

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