Publication: Características morfológicas, biomecánica y tonometría comparada en queratoplastia
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2022-10-27
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Universidad Complutense de Madrid
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Abstract
La queratoplastia es un procedimiento quirúrgico en el cual una cornea enferma de un sujeto se reemplaza por una cornea donante sana con la finalidad de restaurar la integridad y transparencia de la misma. Existen dos tipos de queratoplastia: penetrante (QPP), en la cual se sustituye todo el espesor del tejido, y lamelar, en la que se sustituye solo la capa afecta de la córnea. Dentro de las técnicas lamelares podemos distinguir la queratoplastia lamelar anterior profunda (DALK),las queratoplastias endoteliales (DSAEK y DMEK).Se estima que la incidencia de glaucoma post queratoplastia es del 9 al 31% en el postoperatorio inmediato. Del 18 al 35% de los pacientes trasplantados de córnea lo desarrollarán con posterioridad. La causa por la que se produce un aumento de presión intraocular (PIO) es multifactorial: alteraciones en el ángulo con aparición de sinequias anteriores, inflamación pre y postoperatoria, tratamiento corticoideo prolongado, aspectos relacionados con la técnica quirúrgica (suturas apretadas, trépanos pequeños) con distorsión angular agravadas por el edema y la inflamación, que puede terminar colapsando la función filtrante de la malla trabecular. La detección precoz del glaucoma en estos pacientes es muy importante, ya que representa la segunda causa de fracaso de trasplante corneal solo superada por el rechazo secundario al fallo endotelial. Su gravedad es proporcional a la duración y la magnitud del aumento de PIO...
Keratoplasty is a surgical procedure in which a diseased cornea of a subject is replaced by a healthy donor cornea in order to restore its integrity and transparency. There are two types of keratoplasty: penetrating (PPK), in which the entire thickness of the tissue is replaced, and lamellar, in which only the affected layer of the cornea is replaced. Within lamellar techniques we can distinguish deep anterior lamellar keratoplasty (DALK), endothelial keratoplasties (DSAEK and DMEK). The incidence of postkeratoplasty glaucoma is estimated to be 9% to 31% in the immediate postoperative period. From 18 to 35% of corneal transplant patients will develop glaucoma later. The cause for an increase in intraocular pressure (IOP) is multifactorial: alterations in the angle with the appearance of anterior synechiae, pre and postoperative inflammation, prolonged corticosteroid treatment, aspects related to the surgical technique (tight sutures, small trephines) with angular distortion aggravated by edema and inflammation, which can end up collapsing the filtering function of the trabecular meshwork. The early detection of glaucoma in these patients is very important, since it represents the second cause of corneal transplant failure, second only to rejection secondary to endothelial failure. Its severity is proportional to the duration and magnitude of the IOP increase...
Keratoplasty is a surgical procedure in which a diseased cornea of a subject is replaced by a healthy donor cornea in order to restore its integrity and transparency. There are two types of keratoplasty: penetrating (PPK), in which the entire thickness of the tissue is replaced, and lamellar, in which only the affected layer of the cornea is replaced. Within lamellar techniques we can distinguish deep anterior lamellar keratoplasty (DALK), endothelial keratoplasties (DSAEK and DMEK). The incidence of postkeratoplasty glaucoma is estimated to be 9% to 31% in the immediate postoperative period. From 18 to 35% of corneal transplant patients will develop glaucoma later. The cause for an increase in intraocular pressure (IOP) is multifactorial: alterations in the angle with the appearance of anterior synechiae, pre and postoperative inflammation, prolonged corticosteroid treatment, aspects related to the surgical technique (tight sutures, small trephines) with angular distortion aggravated by edema and inflammation, which can end up collapsing the filtering function of the trabecular meshwork. The early detection of glaucoma in these patients is very important, since it represents the second cause of corneal transplant failure, second only to rejection secondary to endothelial failure. Its severity is proportional to the duration and magnitude of the IOP increase...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 24-05-2022