Transscleral Cyclophotocoagulation for Refractory Intraocular Pressure Elevation after Penetrating Keratoplasty.

Abstract

Prcis: Transscleral cyclophotocoagulation significantly reduces intraocular pressure and antiglaucomatous medication use post-penetrating keratoplasty, with low hypotony risk, particularly if delayed. Safe reintervention is feasible for intraocular pressure recurrence.

Purpose: Transscleral cyclophotocoagulation (TSCPC) is an established procedure for lowering intraocular pressure (IOP). We aimed to evaluate the therapeutic efficacy and the safety of TSCPC in patients with refractory IOP elevation after penetrating keratoplasty (PK), as well as to identify risk factors associated with postoperative hypotony.

Patients and methods: TSCPC was performed in 52 eyes with inadequate pressure regulation despite maximal conservative therapy after PK. All the patients were reviewed at day one, one month, six months and one year after the TSCPC. A diagnosis of hypotony was considered if the IOP was lower than 6 mmHg at any time postoperatively. Multivariate analysis was applied to identify risk factors for hypotony and elevated IOP recurrence.

Results: The IOP value decreased significantly from the median baseline of 29.1±0.7 mmHg to 15.1±0.8 mmHg at one year follow-up. The number of antiglaucomatous medications was significantly reduced one year after TSCPC (2.9±0.1 vs. 2.4±0.2; P<0.01). Only six (11.5%) patients developed transitory hypotony. The mean time between PK and TSCPC was significantly lower (P<0.01) in patients who developed hypotony (5.8±2.2 mo vs. 28.9±5.7 mo). 53.8% of cases had a relapse of IOP increase at any time point during the follow-up. Reintervention with TSCPC was performed in 42.4% of patients.

Conclusion: TSCPC after PK reduces significantly IOP and the number of antiglaucomatous medications. The rate of postoperative hypotony is low. Patients with shorter time interval between PK and TSCPC are at higher risk of developing hypotony. TSCPC can be safely reperformed in patients after PK.