Glaucoma after Keratoplasty – a Current Review.
Wydanie 1/2021
str. 32 – 36
Autor: Katarzyna Gontarz1,2, Mariola Dorecka1,2, Ewa Mrukwa-Kominek1,2
1 Klinika Okulistyki Katedry Okulistyki Wydziału Nauk Medycznych w Katowicach Śląskiego Uniwersytetu Medycznego w Katowicach
Kierownik: prof. dr hab. n. med. Ewa Mrukwa-Kominek
2 Oddział Okulistyki Dorosłych Uniwersyteckiego Centrum Klinicznego im. prof. K. Gibińskiego Śląskiego Uniwersytetu Medycznego w Katowicach
Kierownik: prof. dr hab. n. med. Ewa Mrukwa-Kominek
Summary:
Post-keratoplasty glaucoma is one of the most common and serious complications of corneal transplantation. It adversely affects the graft and damages the optic nerve. It is difficult to diagnose, monitor and treat. The universally acknowledged post-keratoplasty glaucoma definition deviates from the classic definition of glaucoma. The aim of the work is to review the current state of knowledge in the field of epidemiology, pathogenesis and treatment of post-keratoplasty glaucoma. In the early postoperative period, the incidence of post-keratoplasty glaucoma is estimated at 5.5–31.0%, in the late at 16.6–46.5%. Penetrating keratoplasty is complicated by glaucoma more often than lamellar keratoplasty. The identification of risk factors for post-keratoplasty glaucoma (e.g. preexisting glaucoma or aphakia) allows for careful observation of patients from risk groups. The pathogenesis of post-keratoplasty glaucoma is multifactorial and include e.g. inflammation, disturbed architecture of the angle region (especially in aphakic eyes), surgical factors and steroid therapy.
Possible adverse effects of anti-glaucoma eye drops on the graft are discussed in this paper. The paper also presents those surgical or laser methods of post-keratoplasty glaucoma treatment that are traditionally considered effective, i.e. trabeculectomy with mitomycin C (especially in phakic eyes), glaucoma drainage devices and cyclodestructive procedures. Particular attention was paid to the use of novel methods. The results of the few available studies (on Ex-PRESS and XEN implants) are promising, but more research is needed to determine their effectiveness and safety. As reported in the literature, in well-controlled post-keratoplasty glaucoma it is possible to obtain similar results in the survival of the graft in eyes without and with post-keratoplasty glaucoma. One should never lose vigilance in controlling this complication in patients after keratoplasty.