关键词: 穿透性角膜移植术/并发症, 继发青光眼, 抗青光眼治疗

Abstract: Objective To investigate the treatment efficacy of the secondary glaucoma after penetrating keratoplasty (post-penetrating keratoplasty glaucoma, PPKG). Design Retrospective case series. Participants 34 patients（34 eyes）with PPKG in Beijing Tongren Hospital from January 2010 to January 2013. The primary diseases were as the following: 12 eyes of ocular trauma, 6 eyes of  bullous keratopathy in aphakic or pseudophakic eyes, 4 eyes of adhesive walleye, 4 eyes of corneal ulcers. There were 23 eyes of high-risk corneal keratoplasty. Methods A retrospective clinical data of patients, including corrected visual acuity, intraocular pressure(IOP), anterior segment slit lamp, ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) were reviewed. Patients were treated thoroughly with IOP lowering medications, if which was ineffective the glaucoma surgery underwent. Clinical efficacy criteria: after appropriate treatment, IOP ≤21 mmHg or needn't any medication in the end is effective, > 21 mmHg as invalid. The follow-up time was 6～18 months (mean 12.21±3.86 months). Main Outcome Measures IOP. Results In the 34 eyes, 11 eyes (32.4%) used local or systemic hypotensive drugs, 23 eyes (67.6%) used drug and operation treatment. It was found that in the 23 cases who accepted the glaucoma operation, 11 eyes were operated 1 time, 8 eyes 2 times, 2 eyes 3 times , 2 eyes 4 ~ 5 times. Surgical options consisted of diode laser cyclophotocoagulation in 7 eyes, ciliary body cryotherapy in 2 eyes, cyclophotocoagulation, ciliary body cryotherapy in 5 eyes, cyclophotocoagulation, cyclocryotherapy, trabeculectomy in 5 eyes, cataract extraction and small beam excision of anterior vitrectomy + pupil forming operation in 1 eye, cyclophotocoagulation, trabeculectomy in 1 eyes, EX-PRESS drainage screw implantation in 1 eye, trabeculectomy, cyclophotocoagulation, cyclocryotherapy, cyclodialysis + cyclophotocoagulation 1 eye. At the end of the follow-up, in the 11 eyes who simply used the IOP lowering drugs, 5 eyes (45.5%) did not need any drug treatment in the end, 5 eyes (45.5%) still needed 1~2 kinds of intraocular pressure lowering drops, 1 eye (9%) invalid; in the 23 eyes who accepted the operations, 6 eyes (26.1%) did not need any drug treatment, 12 eyes (52.2%) still needed 1~2 kinds of intraocular pressure lowering drops, 2 eyes (8.7%) still needed 3 kinds of drops, 3 eyes (13%) invalid. Conclusion  More than half of the patients with PPKG still need 1 to 2 kinds of intraocular pressure lowering medications after ocular hypotensive drugs and surgery.

Key words: penetrating keratoplasty/complicatoins, secondary glaucoma；anti-glaucoma therapy