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AJ Fell, G Kobiliris, K Engelmann; Penetrating Keratoplasty in Patients With Known Preoperative Glaucoma . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4173.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report the rate of transplant rejection and failure, endothelial cell density, intraocular pressure (IOP) and visual acuity in patients with primary, secondary or congenital glaucoma who underwent penetrating keratoplasty. High intraocular pressure is one of the risk factors for graft failure. Methods: 85 cases of keratoplasty in 60 patients between 1984 and 2000 with known preoperative glaucoma were retrospectively analyzed. The diagnosis of glaucoma was defined as the known history of glaucoma with antiglaucomatous medication or prior surgery for glaucoma. At presentation, 20 eyes had primary glaucoma, 57 eyes had secondary glaucoma, 8 eyes presented with congenital glaucoma. Follow-ups were done at 1 week, 1 and 4 months, 1,2,3,4 years and included visual acuity, IOP, occurrence of transplant rejection or failure and endothelial cell density count. Results: The mean follow-up was 20 (SD 17) months. In 16 patients, one graft rejection or failure was noted, in further 3 patients, graft rejection or failure occurred twice. Of these 19 patients, only 7 patients had experienced decompensation of IOP (≷20 mm Hg) in the period between operation and graft rejection or failure. At the last examination, decompensated IOP was found in 20 eyes whereas in 55 eyes IOP was normal. No reliable data could be obtained in 10 eyes. Mean endothelial cell count of the transplant before transplantation was 2518 cells/mm². During follow-up, endothelial cell loss was 866 cells/mm² on average. Within the follow-up period, visual acuity increased in 19 eyes, remained stable in 42 eyes and deteriorated in 10 eyes. No data were obtained in 14 eyes. Conclusion: 22 % of all eyes experienced at least one graft rejection or failure. Among these, 63 % had no elevated IOP during follow-up. Thus, we conclude that transplant rejection or failure occurs independently of IOP decompensation in the majority of cases.
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