Posters

Incidence and risk factors of ocular hypertension/glaucoma after Descemet's stripping automated endothelial keratoplasty (DSAEK)

Poster Details

First Author: M. Elalfy UNITED KINGDOM

Co Author(s):    D. Leung   D. Lake   S. Hamada              

Abstract Details

Purpose:

Ocular hypertension(OHT) is a widely recognised complication of DSAEK. Certain risk factors are associated with post-graft OHT, such as pre-existing glaucoma and prolonged steroid use. We aim to evaluate the incidence, demographics, associated risk factors, management and clinical outcomes of ocular hypertension/glaucoma after DSAEK.

Setting:

Queen Victoria Hospital, East Grinstead, UK

Methods:

A retrospective case review of all the NHS patients that underwent DSAEK from 2009 to 2013 with at least 1-year follow up. A total of 81 eyes were included. Ocular hypertension was defined as grafted eyes with IOP elevation >21mmHg or ≥ 6mmHg from baseline at any postoperative visits. Patients with preexisting glaucoma and immediate postoperative IOP elevation were excluded. The incidence, risk factors, response to antiglaucoma treatment, graft failure and visual acuity development were evaluated.

Results:

The incidence of ocular hypertension was51.9% and of post-DSAEK glaucoma is 13.6%. Steroid-induced IOP elevation was the most frequent cause, with an incidence of 38.3%. Risk factor such as pseudophakia and preoperative IOP>16 were found to be associated with post-DSAEK ocular hypertension(p=0.024, p=0.003). Logistic regression analysis showed that 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). In all cases, IOP elevation was treated effectively by steroid switching and tapering, and/or anti-glaucoma medication. There was no negative effect of OHT on visual acuity and graft status.

Conclusions:

OHT is common after DSAEK. Although steroid-induced IOP elevation was the most frequent cause, other reasons associated with development of post-DSAEK glaucoma include graft dislocation and detachment. Eyes with preoperative IOP>16 may require close monitoring of IOP. Management by medical treatment results in good visual acuity and graft status.

Financial Disclosure:

NONE