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.