Eyeworld

94 | EYEWORLD | MARCH 2020 G UCOMA Contact Vu: priscilv@uci.edu DMEK, and DSAEK within the 2 years following corneal sur- gery. The incidence of glaucoma surgery after PKP, DMEK, and DSAEK was 6%, 7%, and 8%, respectively. Outcomes from an unrelated pro- spective investigation showed that the inci- dence of IOP eleva- tion after keratoplasty and development of glaucoma were significantly decreased with anterior lamellar keratoplasty (ALK) and DSAEK compared with PKP. It identified a 10-year cumulated incidence of elevated IOP of 46.5% and an elevated IOP requiring treatment of 38.7% in 1,657 consecutive eyes undergoing corneal transplantation between 1992–2013. The investigators attributed the differences in glaucoma development to dimin- ished surgery-induced damage to the anterior chamber angle and trabecular meshwork, and to the reduced postoperative use of steroids. The 10-year probability of loss of vision related to glaucoma was highest after PKP (3.6%), compared to DSAEK (1%) and ALK (2.1%) (P=.036). 1 "In the postoperative period, endothelial keratoplasties when compared to penetrating keratoplasties provide lower IOP and less need for topical steroids at most postoperative time points up to 2 years," Dr. Vu said. "We saw no significant reduction in the need for glau- coma drops or glaucoma surgery at the 2-year follow-up. This information may be used to help guide surgical decision making and postop- erative care considerations. Limitations of the study include small sample size, single center study, patients lost to follow-up, as well as differences in age and gender between groups. Future studies can expand on numbers as well as provide matched comparisons." The mean age of PKP patients was 49 years, which differed significantly from the mean ages in DSEK patients (74 years) and DMEK (75 years) (p<.001). The male to female ratio in the three surgical groups was: 72:55 PKP, 38:28 DSEK, 17:9 DMEK. The three major indications for corneal surgery included Fuchs dystrophy, post- operative edema and/ or scars, and trauma and/or ulceration. The outcomes revealed no significant difference in preoperative IOP among the three groups. The IOP for the PKP eyes was higher than after DMEK and DSEK at postop week 1 (POW1), postop month 1 (POM1), POM6, and POM24 (p<.05). The IOP for PKP was higher than DMEK but not DSEK at POM12 (p=.028). There was no significant difference in IOP between DMEK and DSEK at all time points. The need for glaucoma medications was assessed at each time point within the three groups. The results indicated that more glauco- ma medications were required for DSEK than for DMEK and PKP at postop day 1 (POD1) and POW1 (p<.05). Also, more glaucoma med- ications were used for DSEK than for DMEK but not for eyes that underwent PKP at POW3 and POW13 (p<.05). The study did not identify a significant difference in the use of glaucoma medications at the 2-year mark. Steroid use revealed a decided difference between PKP and DMEK/DSEK. The mean daily frequency of steroid drops was higher for PKP than DMEK and DSEK at POM3, POM6, POM12, POM18, and POM24 (p<.05). Need for additional glaucoma surgery Dr. Vu and her team observed no significant difference in the postop glaucoma surgery incidence among eyes that underwent PKP, continued from page 92 Reference 1. Borderie VM, et al. Incidence of intraocular pressure elevation and glaucoma after lamellar versus full-thickness penetrating keratoplasty. Ophthalmology. 2016;123:1428–1434. Relevant disclosures Vu: none "In the postoperative period, endothelial keratoplasties when compared to penetrating keratoplasties provide lower IOP and less need for topical steroids at most postoperative time points up to 2 years." —Priscilla Vu, MD

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