Evaluation of the Risk Factors for De Novo Intraocular Pressure Elevation after Penetrating Keratoplasty.

OBJECTIVES

We analyzed prevalence, ocular risk factors, and medical/surgical management of eyes with de novo intraocular pressure elevation following penetrating keratoplasty.

MATERIALS AND

METHODS

In this retrospective study, we assessed 400 patients who underwent penetrating keratoplasty from January 2018 to August 2024 for de novo intraocular pressure elevation during the postoperative follow-up period. We evaluated patient demographics, ocular risk factors, indications for penetrating keratoplasty, topical steroid use, peak and regulated intraocular pressure, need for antiglaucomatous medication/surgery, and mean follow-up time.

RESULTS

After exclusion of eyes with preexisting glaucoma, 55 of 400 patients (13.7 % ) showed intraocular pressure elevation. Postoperatively, mean peak intraocular pressure was 31.92 ± 6.24 mm Hg. To achieve intraocular pressure control, an average of 2.12 ± 0.84 topical antiglaucoma medications were administered. Eleven patients (20 % ) required surgical intervention. Eyes with peripheral anterior synechiae had an increased risk of the need for antiglauc-omatous surgery (P = .03; odds ratio 0.175; 95% CI, 0.035-0.868 ). In addition, significantly higher prevalence of peripheral anterior synechiae was demonstrated among eyes with intraocular pressure elevation occurring within the first 24 weeks postoperatively (P = .03 ). Peak intraocular pressure levels were higher in aphakic eyes (P = .04; odds ratio 0.87; 95 % CI, 0.77 -0.99 ). Furthermore, the peak (P = .02; odds ratio 0.85; 95 % CI, 0.74 -0.98) and regulated (P = .02; odds ratio 0.7; 95 % CI, 0.51 -0.95) intraocular pressures in the postoperative period were significantly higher in eyes that had undergone tectonic penetrating keratoplasty.

CONCLUSIONS

Eyes with preexisting peripheral anterior synechiae, aphakia and eyes undergoing penetrating keratoplasty for tectonic reasons are more vulnerable to postoperative intraocular pressure elevation/glaucoma. Early onset of intraocular pressure issues may be linked to preexisting inflammation and extended use of strong topical steroids, which highlights the importance of proactive care and effective management to prevent complications.