RESUMO
BACKGROUND: Lamellar keratoplasties, e.g. Descemet's stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) are considered the procedures of choice for corneal endothelial diseases. In comparison to penetrating keratoplasty (PK) they are associated with faster visual rehabilitation, a lower risk of complications and a decreased necessity for follow-up visits, which reduces the burden on quality of life in elderly patients. In order to advise patients regarding the indications for surgery and to facilitate the follow-up management, it is important to know the most important complications associated with these keratoplasty techniques. RESULTS AND DISCUSSION: The most important preoperative complication is a delayed indication for the operation. In contrast to PK, DSAEK and DMEK surgery should be provided at an earlier stage of disease as chronic edema alters the stroma and reduces the speed of visual recovery. The most important complications during or early after surgery are detached lamellae, pupillary blocks with increased pressure or air bubbles in the vitreous cavity in patients with previous vitrectomy. The main long-term complications include chronic increased intraocular pressure and immune-mediated graft rejections in DSAEK patients after reducing or stopping topical corticosteroid therapy. This article describes the potential complications of endothelial keratoplasty and provides a detailed explanation of strategies to avoid these complications.
Assuntos
Doenças da Córnea/etiologia , Doenças da Córnea/terapia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Traumatismos Oculares/terapia , Rejeição de Enxerto/etiologia , Hipertensão Ocular/etiologia , Doenças da Córnea/diagnóstico , Medicina Baseada em Evidências , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/etiologia , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/prevenção & controle , Humanos , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/prevenção & controle , Resultado do Tratamento , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Transtornos da Visão/prevenção & controleAssuntos
Corpo Ciliar/lesões , Ferimentos Oculares Penetrantes/cirurgia , Injeções Intravítreas/efeitos adversos , Ranibizumab/administração & dosagem , Ranibizumab/efeitos adversos , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/efeitos adversos , Neovascularização de Coroide/complicações , Neovascularização de Coroide/tratamento farmacológico , Corpo Ciliar/patologia , Corpo Ciliar/cirurgia , Ferimentos Oculares Penetrantes/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Técnicas de Sutura , Resultado do Tratamento , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidoresRESUMO
PURPOSE: The aim of this study was to assess whether intraoperative testing of silicone Ahmed glaucoma valves (AGVs) would identify valves with an increased risk of low postoperative intraocular pressure (IOP). METHODS: In 30 consecutive cases of glaucoma surgery with AGV implantation, after priming the AGV, we intraoperatively measured the opening pressure A, closing pressure B, and re-opening pressure C using the active infusion pump of a phako-machine. IOP was checked postoperatively on the same day. Low IOP was defined as <5 mm Hg. Intraoperatively measured pressure characteristics of the valve function were analysed for their ability to predict postoperative IOP outcomes. RESULTS: Opening A, closing B, and re-opening C pressures (mean, (SD)) were 18.4 (5.1), 8.3 (4.7), and 11.7 (4.8)mm Hg, respectively. Ten patients (33.3%) had low IOP. An opening pressure of ≤18 mm Hg predicted low postoperative IOP with a sensitivity (10/10) of 100% (95% CI, 69.2-100) and a specificity (13/20) of 65.0% (95% CI, 40.8-84.6). CONCLUSIONS: AGVs have a high variability of opening, closing, and re-opening pressures. An opening pressure of ≤18 mm Hg, a closing pressure of ≤10 mm Hg, or a re-opening pressure of ≤11 mm Hg identified all patients with low postoperative IOP.