What causes elevated IOP following penetrating keratoplasty for glaucoma?

Updated: Dec 30, 2020
  • Author: Shibandri Das, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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The causes of elevated IOP in the early postoperative period are as follows:

  • Preexisting open-angle glaucoma
  • Postoperative inflammation
  • Viscoelastic substances
  • Wound leak with angle closure
  • Operative technique
    • Tight suturing and long bites with compression of the angle
    • Unequal suture bites on either side of the wound
    • Larger recipient bed compared with donor tissue size
    • Thicker recipient corneas
  • Increased peripheral corneal thickness
  • Pupillary block glaucoma
  • Penetrating keratoplasty in aphakic eyes secondary to mechanical angle collapse

The causes of elevated IOP in the late postoperative period are as follows:

  • Penetrating keratoplasty in aphakic eyes
  • Penetrating keratoplasty combined with cataract extraction
  • Preexisting primary open-angle glaucoma
  • Steroid-induced glaucoma
  • Graft rejection with glaucoma
  • Ghost cell glaucoma
  • Pupillary block
  • Malignant glaucoma
  • Progressive synechial closure
  • Misdirected aqueous or ciliary block (malignant) glaucoma
  • Epithelial downgrowth
  • Fibrous ingrowth

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