Incidence, Risk Factors and Treatment Outcomes of Intraocular Hypertension and/or Glaucoma Post-Penetrating Keratoplasty: A 5-Year Lebanese Retrospective Descriptive Study

Abstract

Wassef Chanbour,1,2 Mohammad Hussein Ayoub,2 Evelyne Towair,2 Mohamad Darwish,2 Henry Fakhoury,1,2 Pramod Warhekar,3 Elias Jarade1– 3 1Department of Ophthalmology, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon; 2Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon; 3Mediclinic Dubai Mall, Dubai, United Arab EmiratesCorrespondence: Elias Jarade Email [email protected]: Glaucoma is one of the most common complications post-penetrating keratoplasty (PK). In this study, we report the Incidence, risk factors and treatment outcomes of intraocular hypertension (IOH) or/and glaucoma post-penetrating keratoplasty (PKG).Methods: A 5-year descriptive retrospective study, Lebanese patients who underwent PK at Beirut Eye & ENT Specialist Hospital, between 2012 and 2017, were included. Patients with history of glaucoma were excluded. IOH/PKG cases that necessitate treatment were identified and analyzed for the incidence, risk factors and treatment outcomes.Results: A total of 189 eyes of 159 patients were included, with male/female ratio 1.6 and the mean age 47.2± 21.3 years. Bullous keratopathy (BK) presented with a high mean age: 70.3 years while ectasia patients were the youngest: 36.5 years. 34.9% of eyes developed high IOP within a mean of 25 months of follow-up distributed between sub-groups of patient with corneal ectasia (22.5%), redo-PK (51.2%), bullous keratopathy (BK) (50%), keratitis (24.9%), and others (dystrophy, trauma …) (21.4%). High IOP developed in 67.4% of the diabetic patients. Visual acuity was less likely to improve in cases developing elevated IOP while postoperative complications were significantly high. In those refractory to medical treatment, trabeculectomy as a glaucoma surgery was effective in lowering the IOP. Combining procedures with PK was not a risk factor for glaucoma. Interrupted sutures and higher number of suturing were associated with increased IOP levels.Conclusion: IOH developed in one out of three patients who underwent penetrating keratoplasty. DM, bullous keratopathy, infectious keratitis and redo-PK were highly associated with PKG, whereas high IOP was less likely to develop in cases with keratoconus. Glaucoma is considered a poor prognostic factor in patients post-PK.Keywords: penetrating keratoplasty, glaucoma, intraocular hypertension

Keywords

• penetrating keratoplasty
• glaucoma
• intraocular hypertension.