Huang OS, Mehta JS, Htoon HM, et al.
期刊名称：American Journal of Ophthalmology
眼压 成形术 角膜
目的：报告深度前角膜成形术（DALK）后眼压升高的发病率和危险因素。设计：回顾性病例研究。方法：一项回顾性研究，调查了三级中心2004至2008年间5年DALK后IOP升高的病例。少于6个月随访的患者被排除在外。眼压升高定义为IOP21 mmHg。结果：眼压升高发生率36.1%（44/122例），11.4%（n=5）发生在一周之内。眼压升高平均持续48.9天（SD65.5）。导致瞳孔与空气隔离，肿胀移植和皮质类固醇反应。有3例需要外科干预降低眼压（6.8%）。在多变量分析中，DALK前使用0.1%奥洛他定或者环孢菌素滴眼液（OR=14.41,95%CI=1.43-147.23）和DALK后使用1%外用泼尼松龙醋酸盐或者1%地塞米松，DALK后IOP升高发生率更高（OR=4.79,95%CI=0.73-31.52）。DALK后5年时，71例患者里有3人（4.48%）发展成新生青光眼缺陷，1名以前就有青光眼的患者青光眼缺陷发生了进展。结论：我们的研究认为DALK与术后一过性眼压升高显著相关，而与5年新生青光眼关联不显著。 DALK后IOP升高的风险因素包括使用1%外用泼尼松龙醋酸盐或者0.1%地塞米松，以及DALK前使用0.1%奥洛他定或者任何浓度的环孢菌素滴眼液。
Purpose：To report the incidence and risk factors of elevated IOP following deep anterior lamellar keratoplasty (DALK).
Design：A retrospective case series.
Methods：A retrospective study investigating the 5-year incidence of raised IOP following DALK cases performed from 2004 to 2008 in a tertiary center. Patients with less than 6months of follow-up were excluded. Elevated IOP was defined as IOP >21mm Hg.
Results：An episode of elevated IOP occurred in 36.1% of cases (44/122 cases), 11.4% (n= 5) occurring within the first week. The average duration of raised IOP was 48.9 (SD: 65.5) days. Causes included pupil block from air, swollen grafts, and corticosteroid response. Surgical intervention to lower IOP was required in 3 cases (6.8%). In multivariate analyses, the use of Olopatadine 0.1% or cyclosporine eye drops before DALK (OR=14.51, 95% CI= 1.43–147.23) and use of topical prednisolone acetate 1% compared with dexamethasone 0.1% post DALK (OR= 4.79, 95% CI=0.73–31.52) were associated with higher rates of elevated IOP post DALK. At 5 years post DALK, 3 of 71 cases (4.48%) developed de novo glaucomatous field defects, and 1 case with pre-existing glaucoma had progression of glaucomatous field defect.
Conclusions：DALK was associated with a significant incidence of transiently elevated IOP postoperatively, but had a low incidence of de novo glaucoma at 5 years in our study. Risk factors for raised IOP post DALK included the use of topical prednisolone acetate 1% compared with dexamethasone 0.1%, and the use of Olopatadine 0.1% or any concentration of cyclosporine eye drops prior to DALK.