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Pamela Cepeda, Jasbeth Ledesma Gil, Alejandro Navas, David Jesus Islas; Control of intraocular pressure after Ahmed valve implant in patients with penetrating keratoplasty. A retrospective ten-year study.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):928.
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Penetrating keratoplasty is the most common type of transplant practiced worldwide. In spite of its relative frequency, it is not a complication-free procedure. Secondary glaucoma is one of the most common ocular complications and it is per se an important cause of graft failure due to uncontroled intraocular pressure. We performed a retrospective, observational, clinical study to evaluate the incidence of corneal graft survival after Ahmed valve implant and intraocular pressure control in patients with penetrating keratoplasty in a ten-year period and a description of possible associated risk factors.
445 electronic files from january 2001-december 2011 of patients with diagnosis of “penetrating keratoplasty” and “ocular hypertension” or “glaucoma” and with at minimum 6-month follow up were reviewed. Data was collected on a database chart. 95 patients met the final inclusion criteria but only 56 were included for the study.
Mean age was 46.9 years (13-79). 51% male and 49% female. 38 valves in right eyes and 18 left eyes. The causes of penetrating keratoplasty were by frequency: keratoconus, pseudophakic bullous keratopathy, infectious keratitis, corneal dystrophies, trauma and radial keratotomy. Inicial and final visual acuity were 20/1500 ( LogMar -1.53) and 20/800 ( LogMar-1.46). Average preoperative and postoperative intraocular pressure were 30.94 and 17.15mm Hg. 28 corneal grafts (50%) remained clear with a follow-up of 42.26 months (3-120 months). 28 corneal grafts (50%) failed with a follow-up of 15.60 months (0-120 months). All patients had control of intraocular pressure: 15 patients complete success(0 topical medication), 10 patients qualified success (1 medication), 18 patients (2 medications), 11 patients (3 medications) and 2 (4 medications).
The cause of keratoplasty played an important role for graft survival. Some identified risk factors were anterior sinequiae and previous diagnosis of glaucoma whereas age, gender or phakic status were not statistical significant. Control of intraocular pressure is not the only factor involved in graft survival.
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