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Chapter-24 Post Penetrating Keratoplasty Glaucoma

BOOK TITLE: Surgical Techniques in Ophthalmology: Glaucoma Surgery

Author
1. Dada Tanuj
2. Panda Anita
3. Choudhary Sunil
ISBN
9788184489583
DOI
10.5005/jp/books/11383_24
Edition
1/e
Publishing Year
2010
Pages
10
Author Affiliations
2. Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India, Dr RP Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India, RP Centre of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Dr RP Centre for Ophthalmic Sciences AIIMS, Ansari Nagar, New Delhi, Dr RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi-110029, India, Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS Ansari Nagar, New Delhi, India
3. Dr RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi-110029, India
Chapter keywords
glaucoma, penetrating keratoplasty (PK), penetrating keratoplasty (PKP), endothelial cell loss, ophthalmologist, optic nerve head

Abstract

Glaucoma following penetrating keratoplasty (PK) is the most common cause for irreversible visual loss and the second leading cause for graft failure after rejection. Postkeratoplasty glaucoma is a significant clinical problem because of its frequency of occurrence, difficulty in diagnosis and monitoring, and complexity of management. An increase in intraocular pressure at any time after penetrating keratoplasty (PKP) leads to a significant endothelial cell loss, with dire consequences as the endothelial reserve is already low. It is essential for the ophthalmologist to diagnose post PK glaucoma at an early stage and initiate appropriate treatment, so that graft clarity is preserved and the integrity of the optic nerve head is maintained. Important risk factors for glaucoma in patients undergoing PK are included. The pathophysiology of post PK glaucoma is explained. The diagnosis of post PK glaucoma is primarily based on IOP measurements in the early postoperative period, and on IOP, optic disk changes, and progressive visual field changes in the late postoperative period. Management of post PK glaucoma is a complex issue and requires an insight into the pathophysiology leading to elevated IOP. It is important to take appropriate steps during surgery for a primary prevention of this blinding disorder.

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