1Assistant Professor, Department of Ophthalmology, Shridevi Institute of Medical Sciences & Research Hospital, NH-4, Sira Road, Tumkur District, Karnataka State, India
2Senior Resident, Department of Ophthalmology, Shridevi Institute of Medical Sciences & Research Hospital, NH-4, Sira Road, Tumkur District, Karnataka State, India
3Associate Professor, Department of Forensic Medicine & Toxicology, Shridevi Institute of Medical Sciences & Research Hospital, NH-4, Sira Road, Tumkur District, Karnataka State, India
*Corresponding author: Lavanya P Assistant Professor, Department of Ophthalmology, Shridevi Institute of Medical Sciences & Research Hospital, NH-4, Sira Road, Tumkur District, Karanataka State, India. Mobile: 9886301287, E-mail: hrbs2006@yahoo.co.in
Online published on 18 July, 2017.
Glaucoma following penetrating keratoplasty is one of the serious complications due to its frequency of occurrence, difficulty in diagnosis and management, risk of graft failure and irreversible visual loss due to optic nerve damage. The etiology of this disorder is multifactorial and the clear understanding of the various mechanisms that operate during different time frames following penetrating keratoplasty is essential to chalk out the appropriate management algorithms. This study addresses the incidence of glaucoma after penetrating keratoplasty in relation to graft size and the additional surgical procedure.
To study the incidence of glaucoma in penetrating keratoplasty in relation to graft size and additional surgical procedure performed.
Prospective analysis of 100 consecutive eyes which underwent penetrating keratoplasty during the period from September 2009 to December 2010 was done. The patients were followed up for a minimum period of 9 months.
Out of 100 eyes who underwent penetrating keratoplasty on comparing the graft sizes used with the incidence of glaucoma we have observed that risk of post penetrating keratoplasty glaucoma is relatively higher with the graft size 8.5 mm and above with the relative risk of 1.45 and 95% confidence interval being 0.5–4.09, the relative risk of 8.75mm could not be calculated due to small sample. There was no statistically significant difference between the groups (Near significance p=0.08756). On analyzing the two groups of which one group underwent penetrating keratoplasty and the other an additional surgical procedure with penetrating keratoplasty, we observed that there was no statistical difference in the incidence of glaucoma between the two groups with p value of 0.2231 (χ2=1.48, df=1). Among the additional surgical procedures performed combined surgery was done in 41 out of 100 patients (41%). Even though there was no statistically significant difference among the types of surgery (p=0.102), patients undergoing penetrating keratoplasty with anterior chamber intraocular lens implantation were relatively at higher risk to develop glaucoma as compared to posterior chamber intraocular lens implantation. Patients who underwent penetrating keratoplasty with an intraocular lens exchange did not have any risk for development of glaucoma.
Post penetrating keratoplasty glaucoma continues to be a clinical problem that can be sight threatening in its clinical outcome. It is mandatory that IOP is monitored on a regular basis. Recognition of the risk factors namely graft size & associated surgical procedure with penetrating keratoplasty would help in early diagnosis of post penetrating keratoplasty glaucoma.
Penetrating keratoplasty, Graft size, Glaucoma, Intraocular pressure, anterior chamber intraocular lens implantation
