Transcript Post PK glaucoma:our experience

Glaucoma and Penetrating
Keratoplasty : Incidence, Risk
Factors, and Outcomes
Sonika Gupta
Consultant Ophthalmology
Max Eye Care
New Delhi, India
Author has no financial interest
Purpose of the study
To evaluate the incidence, risk factors, treatment
modalities, graft status and visual acuity outcome in
patients with post - Penetrating Keratoplasty (PK)
glaucoma.
Materials and Methods
Retrospective analysis of 260 eyes of 260 consecutive
patients who had undergone PK between 2004 and
2008 was carried out and medical records of patients
diagnosed with post-PK glaucoma were reviewed.
Materials and Methods
Medical records were reviewed for
 Age
 Sex
 Indication for PK
 Preoperative visual acuity
 Evidence of preexisting glaucoma
 Use of antiglaucoma medications and
surgeries performed
Materials and methods
Intraoperative data included
 Details of surgical procedure including type of
surgery and graft size.
 Whether combined with cataract surgery, intraocular
lens removal, intraocular lens exchange, secondary
IOL implantation, anterior vitrectomy
Materials and methods
Follow up information
 Post operative visual acuity
 Status of corneal graft
 Status of anterior chamber
 IOP (as measured by Goldmann applanation
tonometer)
 Disc evaluation in cases where media was
clear
 Type of management: medical therapy,
glaucoma filtering surgery, cyclocryotherapy.
 Final visual outcome and status of graft
Results
Total no. of eyes which had undergone PK- 260 eyes
(of 260 patients)
 Incidence of post PK glaucoma - 11.54% (30/260
eyes)
 Age range- 8-76 years
 20 males , 10 females
 Mean follow up period -15 months

Indications for PK
7%
10%
26%
17%
20%
20%
Adherent
leucoma
Perforated
corneal ulcer
Aphakic bullous
keratopathy
Infective
keratitis
Failed graft
PBK
Results
Aphakia was seen in 13 eyes (43.3%)
 Additional surgical procedures done in 7 eyes
(23.3%) : cataract surgery in 4, anterior
vitrectomy in 3 eyes.
 Pre-existing glaucoma in 6 eyes (20%) out of
which 4 eyes had previous glaucoma filtering
surgery.
 Mean graft size was 8.03 mm.

Treatment modalities
18
16
14
12
no.of 10
cases 8
6
4
2
0
Medical
Therapy
18
Trabeculectom
y + MMC
7
4
1
Treatment
modalities
Cyclodestructi
ve procedures
Vitreous
aspiration +air
injection
Outcome
Clear graft seen in 15 eyes (50%)
 Vision of 20/200 or better in 8 eyes (26.6%)
 Aphakia (odds ratio OR 9.71) and associated surgical
procedures (OR 2.18) were significant risk factors

Fig 1: clear graft in post-PK
glaucoma treated with medical
therapy
Fig.2: Failed vascularized graft
in post-PK glaucoma. IOP controlled
with cyclocryotherapy
Conclusion
Uncontrolled IOP after PK is one of the leading
causes of graft failure and visual loss
 Despite clear grafts, optimal visual outcome may
not be obtained
 It is mandatory to monitor IOP on a regular basis
after corneal transplantation and aggressively
treated if found high.
