1. Glaucoma and Penetrating Keratoplasty : Incidence, Risk Factors, and Outcomes Sonika Gupta Consultant Ophthalmology Max Eye Care New Delhi, India Author has no financial interest

2. Purpose of the study To evaluate the incidence, risk factors, treatment modalities, graft status and visual acuity outcome in patients with post - Penetrating Keratoplasty (PK) glaucoma.

3. Materials and Methods Retrospective analysis of 260 eyes of 260 consecutive patients who had undergone PK between 2004 and 2008 was carried out and medical records of patients diagnosed with post-PK glaucoma were reviewed.

4. Materials and Methods Medical records were reviewed for  Age  Sex  Indication for PK  Preoperative visual acuity  Evidence of preexisting glaucoma  Use of antiglaucoma medications and surgeries performed

5. Materials and methods Intraoperative data included  Details of surgical procedure including type of surgery and graft size.  Whether combined with cataract surgery, intraocular lens removal, intraocular lens exchange, secondary IOL implantation, anterior vitrectomy

6. Materials and methods Follow up information  Post operative visual acuity  Status of corneal graft  Status of anterior chamber  IOP (as measured by Goldmann applanation tonometer)  Disc evaluation in cases where media was clear  Type of management: medical therapy, glaucoma filtering surgery, cyclocryotherapy.  Final visual outcome and status of graft

7. Results  Total no. of eyes which had undergone PK- 260 eyes (of 260 patients)  Incidence of post PK glaucoma - 11.54% (30/260 eyes)  Age range- 8-76 years  20 males, 10 females  Mean follow up period -15 months

8. Indications for PK

9. Results  Aphakia was seen in 13 eyes (43.3%)  Additional surgical procedures done in 7 eyes (23.3%) : cataract surgery in 4, anterior vitrectomy in 3 eyes.  Pre-existing glaucoma in 6 eyes (20%) out of which 4 eyes had previous glaucoma filtering surgery.  Mean graft size was 8.03 mm.

10. Treatment modalities

11. Outcome  Clear graft seen in 15 eyes (50%)  Vision of 20/200 or better in 8 eyes (26.6%)  Aphakia (odds ratio OR 9.71) and associated surgical procedures (OR 2.18) were significant risk factors Fig 1: clear graft in post-PK glaucoma treated with medical therapy Fig.2: Failed vascularized graft in post-PK glaucoma. IOP controlled with cyclocryotherapy

12. Conclusion  Uncontrolled IOP after PK is one of the leading causes of graft failure and visual loss  Despite clear grafts, optimal visual outcome may not be obtained  It is mandatory to monitor IOP on a regular basis after corneal transplantation and aggressively treated if found high.