Visual acuity and intraocular pressure after Descemet's stripping endothelial keratoplasty in eyes with and without preexisting glaucoma.
Visual acuity and intraocular pressure after Descemet's stripping endothelial keratoplasty in eyes with and without preexisting glaucoma.
复制标题
患有和不患有青光眼的眼睛在后弹力层剥离内皮角膜移植术后的视力和眼压。
DOI：
10.1016/j.ophtha.2009.05.034
复制
发表时间：
2009
期刊：
影响因子：
13.7
通讯作者：
Edward,DeepakP
中科院分区：
文献类型：
--
作者：
Vajaranant,ThasaratS;Price,MarianneO;Price,FrancisW;Gao,Weihua;Wilensky,JacobT;Edward,DeepakP
目得：（1）对无青光眼病史和有青光眼病史、有或无青光眼手术史的患者行后弹力层剥脱内皮角膜移植术（DSEK）后眼压（IOP）变化的模式进行分析。(2)比较3组之间的视力和IOP结局。设计：回顾性病历分析。参加者：从2003年12月至2007年8月，由一名外科医生在641名患者中进行的805例DSEK病例在数据库中可用。仅纳入每例患者的首次治疗眼，至少随访1年。400例合格病例：315只眼无青光眼（C）; 64只眼有青光眼，既往无青光眼手术（G）; 21只眼既往有青光眼手术（GS）。分析中纳入了先前存在视网膜问题的眼睛。方法：计算术后眼压升高的发生率。术后IOP升高的研究标准为IOP ≥24 mmHg或IOP较基线升高≥10 mmHg。使用Kruskal-Wallis检验比较3组术前和术后1、3、6和12个月访视时的视力（VA）和IOP。主要观察指标：视力（Snellen）和IOP（毫米汞柱）。结果：根据研究标准，C、G和GS组术后IOP升高的发生率分别为35%、45%和43%。在C、G和GS组中，分别有27%、44%和38%的患者通过开始或增加青光眼药物或减少类固醇药物治疗IOP升高。C组、G组和GS组分别有0.3%、5%和19%的患者接受了后续青光眼手术。与基线相比，只有对照组在12个月时具有统计学显著性IOP升高（中位升高2 mmHg）（P<0.0001）。与基线相比，所有3组在12个月时视力均有统计学显著改善（C和G组12个月中位VA = 20/40; GS组20/50，P<0.0001）。结论：所有组在DSEK后均有大量的IOP升高发生率。需要密切监测IOP。在该队列中，既存青光眼似乎对DSEK后的VA没有负面影响。财务披露：专有或商业披露可在参考文献后找到。
PURPOSE: (1) To characterize the pattern of intraocular pressure (IOP) changes after Descemet's stripping endothelial keratoplasty (DSEK) in patients without preexisting glaucoma and in those with preexisting glaucoma, with and without prior glaucoma surgery. (2) To compare vision and IOP outcomes among the 3 groups. DESIGN: A retrospective chart review. PARTICIPANTS: A total of 805 DSEK cases performed in 641 patients by a single surgeon from December 2003 to August 2007 were available in the database. Only the first-treated eye of each patient with at least 1-year follow-up was included. Four hundred cases qualified: 315 eyes had no glaucoma (C); 64 eyes had glaucoma with no previous glaucoma surgery (G); and 21 eyes had prior glaucoma surgery (GS). Eyes with preexisting retinal problems were included in the analysis. METHODS: Data analysis included calculation of incidence of postoperative IOP elevation. The study criteria for postoperative IOP elevation were IOP ≥24 mmHg or IOP increase ≥10 mmHg from baseline. Kruskal–Wallis test was used to compare visual acuity (VA) and IOP among the 3 groups preoperatively and at 1-, 3-, 6-, and 12-month postoperative visits. MAIN OUTCOME MEASURES: Visual acuity (Snellen) and IOP (millimeters of mercury). RESULTS: The incidence of postoperative IOP elevation by the study criteria was 35%, 45%, and 43% for groups C, G, and GS, respectively. Elevated IOP was medically managed by initiating or increasing glaucoma medications or reducing steroids in 27%, 44%, and 38% of the patients in groups C, G, and GS, respectively. A subsequent glaucoma procedure was performed in 0.3%, 5%, and 19% of patients in groups C, G, and GS, respectively. Only the control group had statistically significant IOP elevation at 12 months (median increase of 2 mmHg) when compared with baseline (P<0.0001). All 3 groups had statistically significant improvement in vision at 12 months when compared with baseline (12-month median VA = 20/40 for C and G; and 20/50 for GS, P<0.0001). CONCLUSIONS: All groups had a substantial incidence of IOP elevation after DSEK. Close monitoring of IOP is warranted. In this cohort, preexisting glaucoma did not seem to have a negative effect on VA after DSEK. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.