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V. Trubnik, N. Harizman, T. Jenkins, A. Jangi, J. A. Seedor, D. C. Ritterband; Incidence of Intraocular Pressure Rise and the Need for Anti-Hypertensive Treatment After Descemet Stripping Automated Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2010;51(13):748.
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To determine the prevalence of intraocular pressure (IOP) elevation and the escalation of glaucoma therapy defined as the need for initiation or addition of IOP lowering treatment, as well as the associated clinical risk factors in patients undergoing Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
82 eyes of 77 patients that had successful DSAEK with at least sixth months follow up were evaluated. The primary outcome measure was elevation of IOP requiring medical or surgical intervention. Risk factors for intraocular pressure escalation were also studied. A univariate logistical regression was used to analyze the data.
Escalation of glaucoma therapy occurred in 17/82 eyes (21%, 95% CI: 0.13,0.31) during a minimum follow up interval of sixth months. Twenty-seven of 82 (33%, 95% CI: 0.24,0.44) eyes that underwent DSAEK had a pre-existing diagnosis of glaucoma; 6 of these twenty-seven eyes had a prior history of glaucoma drainage implant or trabeculectomy. Out of the 17 eyes that experienced an escalation of glaucoma therapy, 16 eyes required additional medical therapy to lower IOP and one eye required surgical intervention. Of the sixteen eyes, 3 presented with increased IOP immediately after surgery, 7 at 3 months, 5 at 6 months and 1 at 12 months. Twenty-seven eyes with a pre-operative diagnosis of glaucoma had an 18% (95% CI: 0.08, 0.37) rate of escalation (5/27) while those without a pre-operative diagnosis of glaucoma had an escalation rate of 22% (95% CI: 0.13, 0.35). No preoperative or perioperative risk factors were found to be statistically related to escalation of therapy.
Overall, less than a quarter of eyes that underwent DSAEK required additional IOP lowering therapy. No clinical risk factors were significantly associated with an escalation of pressure lowering therapy. Long-term follow up and studies with larger sample sizes will be essential to determine whether DSAEK predisposes patients to the future development of glaucoma
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