Transplant size and elevated intraocular pressure. Postkeratoplasty

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Research

Background:

• Elevated intraocular pressure (IOP) is a common complication following keratoplasty, particularly in aphakic (without a lens) or combined lens extraction and keratoplasty procedures.
• Managing postoperative IOP is crucial for successful graft survival and visual outcomes.

Purpose of the Study:

• To investigate the effect of donor graft size on postoperative intraocular pressure in penetrating keratoplasty.
• To determine if using a larger donor button can mitigate the risk of elevated IOP in specific keratoplasty scenarios.

Main Methods:

• A prospective study of 92 consecutive penetrating keratoplasty cases, randomly assigned to two groups.
• Group A received a donor graft 0.5 mm larger than the recipient corneal bed.
• Group B received donor grafts equal in size to the recipient bed. Intraocular pressure was monitored daily postoperatively.

Main Results:

• Group A demonstrated significantly lower intraocular pressures (P < .001) compared to Group B in cases of aphakic penetrating keratoplasty or combined procedures.
• No significant difference in postoperative IOP was observed between the groups for phakic (with lens) penetrating keratoplasties.
• A larger donor button size effectively alleviated induced "aphakic keratoplasty glaucoma".

Conclusions:

• Employing a donor graft 0.5 mm larger than the recipient bed is an effective strategy to reduce postoperative intraocular pressure in aphakic penetrating keratoplasty.
• This technique offers a potential solution for preventing or managing elevated IOP, a known complication of aphakic keratoplasty.
• Graft size matching is critical, with larger donor buttons showing benefit specifically in aphakic and combined procedures.