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L. Au, D. Haider, I. Rahman, C. Fenerty; Glaucoma Control After Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1598.
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To evaluate the effect of penetrating keratoplasty (PK) on intraocular pressure (IOP) control in patients with pre-existing glaucoma. To identify specific risk factors for pressure problem in order to aid post-operative management
Retrospective case note review of all patients undergoing PK between 1st January 2000 and 31st December 2003 at Manchester Royal Eye Hospital identified via the UK transplant database. Pressure problem was defined as an increase in IOP treatment in patients with previously controlled glaucoma.
A total of 195 patients underwent PK during the study period, amongst which 25 patients had pre-existing glaucoma. Nine of them (36%) developed pressure problem during the study period. Kaplan-Meyer survival analysis showed 63% of pre-existing patients maintained adequate glaucoma control without change of treatment at 5 years post PK. Those that developed pressure problem did so within 2 years post PK, with a mean time of 5.78 months.Patients who developed pressure problem had a significantly longer history of glaucoma than those who did not (23.6 vs. 5.05 years, P=0.001). The mean age of the patients who developed pressure problem was also significantly younger than those who did not (55.2 vs. 72.1 years old, p=0.013). Patients suffering from primary open angle glaucoma were significantly less likely to develop pressure problem than those with other types of glaucoma (P=0.041). The pre-transplant IOPs and number of glaucoma treatment between patients who had pressure problem and those who did not were not significantly different. Kaplan-Meyer survival curve of those who had previous glaucoma surgery is consistently lower than those who had medical treatment only at all time points, although the difference is not statistically significant. Three patients required multiple cyclodiode laser treatments for their pressure problems, while one required drainage surgery.
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