The factors of involved in elevated intraocular pressure after the limbal transplantation (LT)
Chiyoko Okamura, Syunji Yokokura, Megumi Uematsu, Akira Kubota,Toru Nakazawa, Nobuo Fuse, Koji Nishida
Department of Ophthalmology and Visual Science Tohoku University Graduate School of Medicine
Objectives:
1) How frequently the elevation IOP
would occur after LT?
2 ) Which factors would be involved in the elevation IOP ?
IOP:intraocular pressure
LT:limbal transplantation
Materials and Methods
●Object of the 19 eyes of 19 patients who undertook LT
( involved in combined with surgical techniques) from June,2005 to August,2009 in Tohoku Uni Hospital.
●The actual IOP was measured at 1,2 and 3 months after surgery.●We investigated how the primary disease ,surgical techniques
and the actual IOP would be involved with the elevation of IOP.
●Eleven eyes with PKP were served as control.
●Anterior chamber angle was investigated over 8 directions to clarify angle open distance(AOD500) and whether or not there was the PAS with UBM.
PKP:penetrating keratoplasty
PAS:peripheral anterior synechia
UBM:ultrasound biomicroscopy
The details of primary disease undertook PKP and LT
・ 11 eyes of patients
(8 males and 3 females).・ The mean age was
60.9±13.7 ※
・ 19 eyes of patients
(14 males and 5 females).・ The mean age was 52.7±15.5 ※※ average±standard deviation
The details of combined surgical techniques with LT
LKP : lamellar keratoplastyAMT: amniotic membrane transplantationDLKP: deep lamellar keratoplasty
Evaluation method of anterior chamber angle with UBM
a:UBM images of normal angle. b: Schematic representation of UBM anterior chamber angle measurement. X: scleral spur. Angle opening distance(AOD500=YZ)is defined as the length of the line drawn from the point on the corneal endothelial surface 500 μm anterior to X to the iris surface perpendicular to the corneal endothelial surface.
Peripheral Anterior Synechiae and Ultrasound Biomicroscopic Parameters in Angle-Closure Glaucoma Suspects
Chungkwon Yoo, Jong Hyun Oh, Yong Yeon Kim, and Hai Ryun Jung
Korean J Ophthalmol. 2007 June; 21(2): 106–110. Published online 2007 June 20. doi: 10.3341/kjo.2007.21.2.106.
a b
X
500μm
Y
Z
Preoperatively
1 month 2 months 3 months
PKP group 9 % 9 % 0 % 0 %
LT group 10.5% 21.0% 42.1% 42.1%
PKP group and the comparison of the LT
p=0.70 p=0.38 p=0.01 p=0.01
表1 眼圧上昇の割合
Results ● Table1 The percentage of patients with IOP > 21mmHg at preoperative,1 , 2
and 3 months.
(Fisher direct test)
The number of the patients whose IOP was over 21 mmHg was significantly larger in LT group than in PKP group at two and three month after surgery ( p = 0.01 ) .
LT+LKP 2 eyes
LT+PKP 2 eyes
LT+AMT 2 eyes
LT+AMT+DLKP 1 eye
alkali burn 2 eyes
bullous keratopathy 1 eye
gelatinous drop-like
corneal dystrophy 1 eye
Stevens-Johnson syndrome 1 eye
burn 1 eye
stem cells exhausted disease 1 eye
1) IOP in 7 of 19 eyes(36.7%) was more than 21mmHg after 3 postoperative months.
2) There were no obvious characters was in combined surgical techniques and primary disease which would increase IOP.
Table2 . Table3.Combined surgical techniques The details of primary disease
The evaluation of anterior chamber angle by UBM parameters ( AOD500 )
Fig1. A comparison of the LT and PKP about AOD. LT group tended to narrow angle compared to PKP.
( LTgroup : AOD150±210μm < PKP group : AOD240±155μm )
The evaluation of PAS by UBM
C:UBM images of PASD:Schematic representation of PAS with
UBM
PAS over 270 degree was observed in 66.7%(8 of 12 eyes)of LT group,
while in 9%(1 of 11 eyes)of PKP group
( P=0.0069 Fisher direct test).
scleral spur
Discussion
chronic inflammation before operation .
↓ PAS (less than 270 degree )
↓ operative invasion (A)suture ligature of corneal limbus
↓ (B)hemostatic coagulation
PAS (more than 270 degree)
↓ Elevated IOP
(A)→ It was possible that because of being flat cornea ,narrow angle was induced.
(B)→operative scar involved aqueous venous around corneal limbus, so aqueous flow resistance was increased.
Conclusion
Patients who underwent LT recognize elevation IOP , as its mechanism was suggested angle closure.
We clarified that patients who undertook LT suffered from elevated IOP.
It may be caused by angle closer.