GLAUCOMA IN THE IMMEDIATE POSTOPERATIVE PERIOD AFTER PENETRATING KERATOPLASTY

In a prospective study 155 consecutive patients undergoing penetrating keratoplasty were examined for postoperative increase in intraocular pressure to determine the frequency and duration of intraocular pressu re spikes, risk factors, and response to treatment. Patients were main tained on preoperative glaucoma medications except miotics. Additional medications to lower intraocular pressure perioperatively were not gi ven. Intraocular pressure was measured two to five hours, one day, and one week postoperatively. An intraocular pressure of 30 mm Hg or grea ter was considered an increase in pressure and was treated according t o a standardized protocol. The results were analyzed by procedure as w ell as by variables commonly perceived to be associated with intraocul ar pressure increase (history of glaucoma, use of hyaluronate, lysis o f the synechiae, or vitrectomy at the time of the operation). Overall, intraocular pressure increases in the early postoperative period occu rred in 18 of 155 patients (12%). Pressure increases occurred in ten o f 48 patients (21%) with a history of glaucoma; five of 24 patients (2 1%) undergoing combined penetrating keratoplasty, extracapsular catara ct extraction, and posterior chamber intraocular lens implantation; an d ten of 43 patients (23%) undergoing vitrectomy at the time of penetr ating keratoplasty.