Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced st...Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced states. The aim of this study was to evaluate the functional outcome and the development of intraocular pressure (IOP) after PK in patients with PEX- keratopathy depending on the presence of pre- exist- ing glaucoma. Patients and Methods: This retrospective study included 21 eyes of 21 patients (age 78.6± 7.5 years) with a mean postoperative follow- up of 1.8 ± 2.2 (median 2) years. The diagnosis of PEX- kerat- opathy was confirmed clinically as well as by electron microscopy. The recipient and donor trephinations were performed from the epithelial side using an 193 nm excimer laser (n=11) or mechanically (n=10). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroid was standardized. Results: Preoperatively, a secondary open- angle glaucoma (SOAG) with optic nerve damage was diagnosed in 11 patients (52% ). Topical antiglaucomatous treatment was needed in 81 % of patients with SOAG. Six weeks postoperatively, patients with SOAG showed a higher prevalence of increased intraocular pressure (IOP) and/or antiglaucomatous treatment compared to patients without SOAG (45% vs. 20% ). Most of the mild- early intraocular pressure elevations were controlled in both groups during the follow- up. From one year post- PK, there was an increased need for topical antiglaucomatous treatment in both patient groups. In all eyes the IOP was controlled by topical antiglaucomatous treatment. Preoperatively, visual acuity was comparable in patients with and without SOAG (0.06 ± 0.09 vs.0.08 ± 0.1, P=0.7), but increased significantly more in patients without SOAG (0.38 ± 0.1, median 0.4) than in patients with SOAG (0.2 ± 0.1, median 0.2; P=0.01) after PK. Visual acuity remained stable in both groups throughout the follow- up period. During followup only one eye developed an episode of reversible endothelial graft rejection 18 months postoperatively. An irreversible graft failure was seen in none of the patients. Conclusion: The functional outcome after PK in PEX- keratopathy seems to be strongly associated with pre- existing SOAG. Patients without SOAG may expect good visual rehabilitation without persistent postoperative IOP increases. However, patients should be followed- up for a prolonged period of time, because from 1 year following PK the need for topical antiglaucomatous treatment increased significantly.展开更多
Purpose: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK)-combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) t...Purpose: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK)-combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) to prevent positive vitreous pressure and its associated complications. Design: Nonrandomized prospective noncomparative interventional case series. Participants: Sixty-five patients who underwent triple procedures between June 2001 and September 2003. Methods: Triple procedures performed on all 65 patients consisted of PK, extracapsular CE, and IOL implantation with standard techniques. After nonpenetrating trephination, anterior vitreous tappingwas performedwith a 23-gauge needle on a 5-ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. Main Outcome Measures: Preoperative best-corrected visual acuity (BCVA), volume of aspirated liquefied vitreous, intraoperative and postoperative complications, and postoperative BCVA at 3 and 6 months. Results: Corneal scarring with cataract was the most common indication for surgery. Preoperative BCVA ranged from 20/160 to light perception. Aspirated vitreous volume varied from 0.3 to 1.5 ml, averaging 1.0 ml. No case had evidence of positive vitreous pressure during surgery. The mean follow-up period was 9.6±2.6months (range,6-24). Postoperative complications consisted of graft rejection in 4 cases (6.2%), primary graft failure in 3 (4.6%), and secondary glaucoma in 1 (1.5%). Of the patients, 70.8%had a postoperative BCVA of ≥20/160 at 6 months. Vitreous hemorrhage, retinal tearing, and detachment were not observed. Conclusions: Pars plana anterior vitreous tapping is a safe adjunct for triple procedures to prevent positive vitreous pressure and its associated complications.展开更多
文摘Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced states. The aim of this study was to evaluate the functional outcome and the development of intraocular pressure (IOP) after PK in patients with PEX- keratopathy depending on the presence of pre- exist- ing glaucoma. Patients and Methods: This retrospective study included 21 eyes of 21 patients (age 78.6± 7.5 years) with a mean postoperative follow- up of 1.8 ± 2.2 (median 2) years. The diagnosis of PEX- kerat- opathy was confirmed clinically as well as by electron microscopy. The recipient and donor trephinations were performed from the epithelial side using an 193 nm excimer laser (n=11) or mechanically (n=10). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroid was standardized. Results: Preoperatively, a secondary open- angle glaucoma (SOAG) with optic nerve damage was diagnosed in 11 patients (52% ). Topical antiglaucomatous treatment was needed in 81 % of patients with SOAG. Six weeks postoperatively, patients with SOAG showed a higher prevalence of increased intraocular pressure (IOP) and/or antiglaucomatous treatment compared to patients without SOAG (45% vs. 20% ). Most of the mild- early intraocular pressure elevations were controlled in both groups during the follow- up. From one year post- PK, there was an increased need for topical antiglaucomatous treatment in both patient groups. In all eyes the IOP was controlled by topical antiglaucomatous treatment. Preoperatively, visual acuity was comparable in patients with and without SOAG (0.06 ± 0.09 vs.0.08 ± 0.1, P=0.7), but increased significantly more in patients without SOAG (0.38 ± 0.1, median 0.4) than in patients with SOAG (0.2 ± 0.1, median 0.2; P=0.01) after PK. Visual acuity remained stable in both groups throughout the follow- up period. During followup only one eye developed an episode of reversible endothelial graft rejection 18 months postoperatively. An irreversible graft failure was seen in none of the patients. Conclusion: The functional outcome after PK in PEX- keratopathy seems to be strongly associated with pre- existing SOAG. Patients without SOAG may expect good visual rehabilitation without persistent postoperative IOP increases. However, patients should be followed- up for a prolonged period of time, because from 1 year following PK the need for topical antiglaucomatous treatment increased significantly.
文摘Purpose: To describe the technique and outcome of pars plana vitreous aspiration during penetrating keratoplasty (PK)-combined with cataract extraction (CE) and intraocular lens (IOL) implantation (triple procedure) to prevent positive vitreous pressure and its associated complications. Design: Nonrandomized prospective noncomparative interventional case series. Participants: Sixty-five patients who underwent triple procedures between June 2001 and September 2003. Methods: Triple procedures performed on all 65 patients consisted of PK, extracapsular CE, and IOL implantation with standard techniques. After nonpenetrating trephination, anterior vitreous tappingwas performedwith a 23-gauge needle on a 5-ml syringe over the pars plana 3.5 mm posterior to the limbus in the superotemporal quadrant. Main Outcome Measures: Preoperative best-corrected visual acuity (BCVA), volume of aspirated liquefied vitreous, intraoperative and postoperative complications, and postoperative BCVA at 3 and 6 months. Results: Corneal scarring with cataract was the most common indication for surgery. Preoperative BCVA ranged from 20/160 to light perception. Aspirated vitreous volume varied from 0.3 to 1.5 ml, averaging 1.0 ml. No case had evidence of positive vitreous pressure during surgery. The mean follow-up period was 9.6±2.6months (range,6-24). Postoperative complications consisted of graft rejection in 4 cases (6.2%), primary graft failure in 3 (4.6%), and secondary glaucoma in 1 (1.5%). Of the patients, 70.8%had a postoperative BCVA of ≥20/160 at 6 months. Vitreous hemorrhage, retinal tearing, and detachment were not observed. Conclusions: Pars plana anterior vitreous tapping is a safe adjunct for triple procedures to prevent positive vitreous pressure and its associated complications.
