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ARTICLES
Year : 1981  |  Volume : 29  |  Issue : 3  |  Page : 167-170

Incidence and management of glaucoma in post operative cases of penetrating keratoplasty


Nehru Institute of Ophthalmology and Research Eye Hospital, Sitapur (UP), India

Correspondence Address:
D C Kushwaha
Nehru Institute of Ophthalmology and Research Eye Hospital, Sitapur (UP)
India
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Source of Support: None, Conflict of Interest: None


PMID: 7049915

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How to cite this article:
Kushwaha D C, Pual A K. Incidence and management of glaucoma in post operative cases of penetrating keratoplasty. Indian J Ophthalmol 1981;29:167-70

How to cite this URL:
Kushwaha D C, Pual A K. Incidence and management of glaucoma in post operative cases of penetrating keratoplasty. Indian J Ophthalmol [serial online] 1981 [cited 2020 Nov 23];29:167-70. Available from: https://www.ijo.in/text.asp?1981/29/3/167/30872

Table 6

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Table 6

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Table 5

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Table 5

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Table 4

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Table 4

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Table 3

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Table 3

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Table 2

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Table 2

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Table 1

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Table 1

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One of the most serious complications of penetrating keratoplasty, is the development of glaucoma in immediate or delayed post operative period[1],[2],[3],[4],[5]. Although there is no actual rejection of the graft but the develop­ment of corneal oedema, pressure symptoms resulting loss of visual acuity which reduces tremendously the success rate unless it is pro­mptly recognised and treated.

The purpose of presenting this paper is to make an attempt to determine the incidence of glaucoma after keratoplasty and their manage­ment by various methods.


  Material and methods Top


185 cases of penetrating keratoplasty were performed between 1974 and 1978, were evalua­ted to determine the incidence of glaucoma. Routine pre-operative examination and investi­gations like slit lamp conjunctival smear test, intra ocular pressure etc. were performed in all the cases. None of these patients had glaucoma before grafting. Patients with adherent leucomas were excluded from this study. The size of the graft varied from 7.0 to 8 mm. and all the operations were done under­operating microscope. The suture material was 10.0 Ethicon.

The post operative management included local and systemic antibiotic therapy alongwith diarnox tabs. (250 mg.) twice daily.


  Observations Top


[Table - 1] represents that intraocular pressure was raised in 74 (40%) cases while in 111 (60%) cases it was found within normal limits. All the cases were examined under slit lamp and the following complications were detected in 17 cases. (Hyphaema 5, Iris prolapse 8, Acute iritis 4).

These cases were subsequently managed by medical and surgical therapy. The prolapsed iris cases were managed by excision of pro­lapsed tissue. The remaining 57 cases who were not responded by medial therapy were subjected to surgery after 15th day of keratop­lasty [Table - 2][Table - 3]. The average follow up of the post operative period was little more than one year in all the cases.

The selection of cases was entirely based on clinical assessment and not on indications of operations.

It was observe that 8 cases out of 15 were satisfactorily relieved from raised intraocular pressure with trabeculec tomy. In rest 7 cases the tension was not relieved. The cause was not clear because of hazy media which obstructed the view of anterior chamber. Most probably it was because of extensive peripheral anterior synechia [Table - 3].

Cyclodialysis controlled the tension in 11 cases satisfactorily as diagnosed on 3 rd day of post operative period but in longer follow up period the tension again elevated in 5 cases. The peripheral anterior synechia again formed as indicated by slit lamp examination so the success rate was reduced. [Table - 4]

Cyclocryotherapy

Out of 23 cases, 14 (60.8%) cases improved satisfactorily. In remaining 9 cases cyclocryo­therapy was repeated and 2 cases again impro­ved to normal. In only 7 cases the tension was not controlled by any means. The graft was rejected and patients were kept only on sympto­matic therapy. [Table - 5]

The table represents the maximum per­centage of success in cyclocryotherapy cases (60.8%).

The other remaining cases of trabeculecto­my and cyclodalysis where the tension was not controlled was also kept for cyclocryotherapy. 9 cases out of 17 cases were relieved [Table - 6]. The cases in which the tension was not relieved, developed complications such as subacute iritis. The cases were managed separately and treated by heavy dozes of systemic cortisone and local drops of cortisone mydriaties and antibiotics etc.


  Discussion Top


Success of keratoplasty is not measured in the terms of visual acuity since the associated changes are also important in maintaining the visual acuity. Most of the post operative com­plications occured in immediate post operative period of keratoplasty is usually related to the pre-operative condition of the eyes such as trichiasis, entropion, infection of the cornea along suture tract etc. Since the operating microscope used in corneal surgery, the post operative flat anterior chamber due to leakage of wound uncommon. Graft rejection is the main biological cause of graft opacification. Inspite of taking all the precautions post opera­tive glaucoma may develop in eyes due to wound closure, anterior chamber haemorrhage and formation of retrocorneal membrane. The incidence of secondary glaucoma after kerato­plasty may also be due to the extensive use of corticosteriods. Inflammatory debris and vitre­ous in anterior chamber may block trabecular meshwork resulting in raised intraoculao pre­ssure. The present study was conducted on those cases of keratoplasty in which the intrao­cular presssure was above the normal level. The cases were first treated by medical therapay by medical therapy including diamox and occasional oral glycerol. The intraocular pressure was reduced to normal in those patients where iritis; hyphaema and iris prolapse was the main factor of increasing the tension. The cases which did not respond to this therapy were subjected to surgical treatment in the form of trabeculecto­my, cyclodialysis and cyclocryotherapy. Trabe­culectomy proved good in these cases where peripheral anterior synechiae were not marked 8 cases (53.3%) were relieved by this treatment. In cases where cyclodialysis operation was performed, the results were not so satisfactory.

Only 6 cases (31.5%) showed improvement while in 13 (68.5%), the tension was not controlled. The cases where, the peripheral anterior synechiae were the causative factor, the tension was not relieved.

In our series of 23 cases, 14 cases (60.8%) showed marked improvement in intraocular pressure with cyclocryotherapy. The repeated application of cyclocryotherapy gradually increased the success rate.

The study denotes that trabeculectomy and cyclocryotherapy is the main remedy for con­trolling the intraocular pressure in post opera­tive period of keratoplasty. Since both surgical procedures are not complicated and can be tried as a routine. Although cyclocryotherapy is a destructive operation but it is the only remedy for satisfactory control in some of the cases.

 
  References Top

1.
Bietti, G., 1950, J. A. M. A., 142, 889.  Back to cited text no. 1
    
2.
Bellow, A.R., Grant, W.M., 1973, Amer. J. Ophthalmol. 75;679-684.  Back to cited text no. 2
    
3.
Irvin, A.R., Kaufmann ME 1969, Amer, J. Ophthalmol. 68,: 835.  Back to cited text no. 3
    
4.
Kaufmanm, H.E. West, C. E. and Wood, T.O. 1970, Int. Ophthalmol. Clin. 10, (No. 2).  Back to cited text no. 4
    
5.
Richard, A. J. James M. Gordon, 1974, Trans, Amer, Acad. of Ophthalmol. & Otol. 78 352.  Back to cited text no. 5
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]



 

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