Document Detail

Graft failure: III. Glaucoma escalation after penetrating keratoplasty.
MedLine Citation:
PMID:  18431550     Owner:  NLM     Status:  MEDLINE    
Glaucoma after penetrating keratoplasty is a frequently observed post-operative complication and is a risk factor for graft failure. Penetrating keratoplasty performed for aphakic and pseudophakic bullous keratopathy and inflammatory conditions are more likely to cause postoperative glaucoma compared with keratoconus and Fuchs' endothelial dystrophy. The intraocular pressure elevation may occur immediately after surgery or in the early to late postoperative period. Early postoperative causes of glaucoma include pre-existing glaucoma, retained viscoelastic, hyphema, inflammation, pupillary block, aqueous misdirection, or suprachoroidal hemorrhage. Late causes include pre-existing glaucoma, angle-closure glaucoma, ghost cell glaucoma, suprachoroidal hemorrhage, and steroid-induced glaucoma. Determining the cause of IOP elevation can help guide therapeutic intervention. Treatments for refractory glaucoma include topical anti-glaucoma medications such as beta-adrenergic blockers. Topical carbonic anhydrase inhibitors, miotic agents, adrenergic agonists, and prostaglandin analogs should be used with caution in the post-keratoplasty patient, because of the possibility of corneal decompensation, cystoid macular edema, or persistent inflammation. Various glaucoma surgical treatments have reported success in post-keratoplasty glaucoma. Trabeculectomy with mitomycin C can be successful in controlling IOP without the corneal toxicity noted with 5-fluorouracil. Glaucoma drainage devices have successfully controlled intraocular pressure in postkeratoplasty glaucoma; this is, however, associated with increased risk of graft failure. Placement of the tube through the pars plana may improve graft success compared with implantation within the anterior chamber. In addition, cyclophotocoagulation remains a useful procedure for eyes that have refractory glaucoma despite multiple surgical interventions.
Emily C Greenlee; Young H Kwon
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  International ophthalmology     Volume:  28     ISSN:  0165-5701     ISO Abbreviation:  Int Ophthalmol     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-10-20     Completed Date:  2008-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7904294     Medline TA:  Int Ophthalmol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  191-207     Citation Subset:  IM    
Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1091, USA.
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MeSH Terms
Glaucoma / etiology*,  surgery
Graft Rejection / etiology*
Intraocular Pressure
Keratoplasty, Penetrating / adverse effects*
Postoperative Complications*
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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