Purpose:
To investigate factors associated with increased intraocular pressure (IOP) following DSAEK.
Methods:
A retrospective cohort study of 222 DSAEK cases from October 2006 to April 2010. Visual acuity (VA), reason for DSAEK, and IOP were recorded preoperatively. IOP elevation was defined as > 24 mmHg. Patients were followed for an average of 11.6 postoperatively. Outcomes measured were VA, IOP, peripheral anterior synechiae (PAS) formation, adjustment of steroid medications, and methods of IOP lowering treatment.
Results:
The most common indications for DSAEK were Fuch's endothelial dystrophy (52.7%), and pseudophakic bullous keratopahy (41.4%). Postoperatively, 29.7% of all patients developed an IOP elevation. The initial IOP spike most commonly occurred during postoperative weeks 3-7. The highest prevalence (16.3%) of patients with uncontrolled IOP was during postoperative months 2-4. Table 1 shows the incidence of elevated IOP at each follow-up period.Patients with preoperative glaucoma (31.5%) were more likely to have uncontrolled IOP at one or more follow-up periods (48.6%). One third of patients with an IOP elevation responded to decreasing their steroid dose, changing to a lower potency steroid, and/or adding a single ocular hypotensive agent.PAS was observed in 12.6% of patients postoperatively and two thirds of these patients required aggressive IOP management.
Conclusions:
Elevated IOP in the delayed postoperative period after DSAEK is most commonly due to steroid response. Preoperative glaucoma is a statistically significant risk factor for postoperative IOP elevation. History of complicated surgeries is a risk factor for the development of PAS and elevated IOP after DSAEK.
Keywords: intraocular pressure • anterior segment • transplantation