Clinical Ophthalmology (May 2021)
Incidence and Risk Factors of Ocular Hypertension/Glaucoma After Descemet Stripping Automated Endothelial Keratoplasty
Abstract
Mohamed Elalfy,1– 3,* Sundas Maqsood,1,* Shady Soliman,3 Sherif Momtaz Hegazy,3 Ahmed Abdou Hannoun,3 Zisis Gatzioufas,1,4 Damian Lake,1 Samer Hamada1 1Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK; 2Eye Department, Maidstone and Turnbridge Wells Hospital, Maidstone, UK; 3Research Institute of Ophthalmology, Giza, Egypt; 4Eye Department, University Hospital Basel, Basel, Switzerland*These authors contributed equally to this workCorrespondence: Mohamed ElalfyQueen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, RH19 3DZ, UKTel +44 01342414560Email [email protected]: To evaluate the incidence, demographics, associated risk factors, management and clinical outcomes of ocular hypertension/glaucoma after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods: A cohort review of 81 DSAEK cases was performed at Queen Victoria Hospital, United Kingdom. Patients with pre-existing glaucoma, transient increased IOP within the first 48 hours post-graft, additional post-transplant surgery, or failed to complete one year follow-up were excluded from the study. Ocular hypertension was defined as intraocular pressure (IOP) elevation > 21mmHg or ≥ 6mmHg from baseline at any postoperative visit. The study looked at the incidence, risk factors, response to anti-glaucoma treatment, graft failure and best corrected visual acuity.Results: The incidence of post-DSAEK ocular hypertension and glaucoma was 51.9% and 13.6%, respectively. Steroid-induced IOP elevation was the most frequent cause, with an incidence of 38.3%. Risk factors such as pseudophakia (p=0.024) and preoperative IOP> 16 (p=0.003) were found to be associated with post-DSAEK ocular hypertension. Preoperative IOP> 16 had 5.27 times risk of IOP elevation. Eyes with graft dislocation and/or detachment were significantly associated with post-DSAEK glaucoma (p=0.038). There was no negative effect of OHT on visual acuity and graft status.Conclusion: Glaucoma and OHT are common postoperative complications of DSAEK. Although steroid-induced IOP elevation was the most frequent cause, there are other reasons associated with development of post-DSAEK glaucoma, including graft dislocation and detachment. Eyes with preoperative IOP> 16 mm Hg may require a close monitoring of IOP. In addition, management by medical treatment results in good visual acuity and graft clarity.Keywords: Descemet’s stripping endothelial keratoplasty, DSAEK, glaucoma, ocular hypertension
