1. OCULAR HYPERTENSION AFTER PENETRATING KERATOPLASTY F Orucov, E Strassman, D Landau, J Frucht-Pery and A Solomon, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel Authors have no financial interests in any of the mentioned products or companies

2. Glaucoma is one of the most frequent and severe postoperative complications of penetrating keratoplasty loss of endothelial cells → graft failure Increased IOP optic nerve damage → visual loss

3. Incidence of glaucoma after penetrating keratoplasty Karesh JW, Am J Ophthalmol 96:160,1983 Thoft RA, Trans Am Acad Ophthalmol 1974;78:352-65 7,3%-33,6%

4. PURPOSE This study evaluated the incidence and risk factors associated with Ocular Hypertension following penetrating keratoplasty

5. Patient Characteristics Number of patients 146 Age (years) 45 ± 20.8 ( 15 – 88) Sex Male 71(48.6%) Female 75(51.4%) IOP (mm Hg) Mean ± SD 13.2 ± 3.7 Range 5-26 High IOP (n) 6(4.1%) Follow-up 24.4±7.5 (12-41 mo.)

6. Pre-op antiglaucoma medications 33 (22.6%) pts. 1 medication 23 pts. 2 medications 7 pts. 3 medications 3 pts. s/p trabeculectomy in 8 pts Glaucoma Prior to PKP

7. KCN: 60(41.1%) FG: 30(20.5%) PBK: 19(13%) SCAR: 12(8.2%) TRAU: 6(4.1%) HSK: 4(2.7%) DISTR: 3(2.1%) BK(other):3(2.1% FUCH: 3(2.1%) PERF: 2(1.4%) ASTIG 1(0.7%) ULC: 1(0.7%) INT.KR:1(0.7%) DIAGNOSIS

8. Previous ocular surgery (n=70) Previous surgery Number Percentage Cataract extraction 22 (15.1) PKP 20 (13.7) Triple procedure 10 (6.8) Trauma, Perforation repair 3 (2.1) Trabeculectomy + ECCE + PKP 3 (2.1) Trabeculectomy + PKP 2 (14) Trabeculectomy + ECCE 2 (1.4) Stem cell transplantation+AMT 2 (1.4) Trabeculectomy 1 (0.7) Vitrectomy + ECCE + PKP 1 (0.7) Retina detachment repair + Vitrectomy 1 (0.7) Retina detachment repair + cataract surgery 1 (0.7) LKP 1 (0.7) PRK 1 (0.7) Total 70 47.9

9. Size of graft: Mean 8.0 mm Range 7.0-9.0 mm Oversize 0.25mm 0.50mm 134 pts. 16pts. Sutures Interrupted 110 (76.1%) pts. Continuous 36 (23.9%) pts.

10. Combined Procedures (with PKP) N=21 (14.4%)

11. Post-PKP Complications 30(20.5%) pts.(%) Rejection 10 (6.8%) Failed Grafts 13 (8.9%) Non-Healing ED 8 (5.5%) Infection 5 (3.4%) Recurrent HSK 2 (1.4%)

12. Mean 27.1± 5.7mmHg (21-49mmHg) Starting - 70.3 days after PKP Lasting - 15.6±16.8 days Topical steroids n=69 Ocular Hypertension after PKP n=70 pts. (47.9%)

13. Ocular Hypertension after PKP Hx of Preexisting Glaucoma New Glaucoma P N 25 45 PostPKP IOP(mmHg) 29.7± 7.0 25.7±4.2 0.02 Starting Time(days) 39.2 ±57.4 87.6±157.6 0.014 N. of Medications 1.5±0.7 1.1±0.36 0.001

14. Treatment pts. (%) 1 medication 47 (69.1%) 2 medications 12 (17.6%) 3 medications 3 (4.4%) Not responsive to anti-glaucoma treatment n=11(7.5%) Glaucoma surgery n=3 Second Episode of High IOP n=35 Ocular Hypertension after PKP

15. Graft Failure in Patients with Postperative Glaucoma 9 of 13 failed grafts (P=0.107). Pre-existing glaucoma was not a cause for graft failure (p=0.152 chi-square test )

16. Significant Risk Factors for Ocular Hypertension after PKP (Univariate analysis *) Risk FactorsP Value Preexisting glaucomap<0.001 Previous ocular surgeryp=0.011 Donor oversize 0.50mmp=0.003 Additional intraocular surgery p<0.001 Pseudophakia, Aphakiap=0.001 *Chi-Square test

17. Multivariate Analysis Preexisting glaucoma p=0.009 Previous ocular surgeryp=0.86 Donor oversize 0.50mm p=0.07 Additional intraocular surgery p=0.007 Pseudophakia,Aphakia p=0.729

18. Conclusions Ocular Hypertension is Common in Patients Post-PKP Pre-Operative Glaucoma and Additional Surgical Procedures are risk factors for Postoperative Ocular Hypertension Monitoring of IOP During all Visits after PKP

19. Summary The incidence of one episode of ocular hypertension after PKP is 47.7% Starting after 70 days Second episode: 24% 7.5% do not respond to topical management