Glaucoma in Keratoplasty: Risk factors, Management and Outcome

Abstract

Purpose: : Glaucoma is a leading cause for graft failure. This retrospective study analyzes the risk factors, graft status, and treatment modalities in patients with post-penetrating keratoplasty glaucoma.

Methods: : A retrospective analysis of case records of 1848 penetrating keratoplasties, between 2000 and 2005 was performed. A total of 160 patients (160 eyes) with post-penetrating keratoplasty glaucoma were included. The assessment included the pre-operative history of corneal disease and glaucoma, the lens status and the anaesthesiological techniques. Furthermore the response to anti-glaucoma treatment, graft failure, and endothelial cell loss was evaluated.

Results: : The incidence of post-penetrating keratoplasty glaucoma was 8.7% (160/1848). Half of the patients (81 patients) responded to medical therapy (51%), the other half of patients (79 patients) to surgical therapy (49%), whereas filtering surgery, and cyclodestructive procedures were performed. One patient got a glaucoma implant. Clear grafts were achieved in 94 eyes (59%). Visual acuity after 24 months of logMar 1.0 or better was achieved in 77 eyes (46%), of logMar 0.4 in 33 eyes (21%).

Conclusions: : Careful and ongoing observation of intra ocular pressure throughout the prolonged follow-up period is recommended for patients after penetrating keratoplasty and prompt attention to intraocular pressure treatment is indicated. But any anti-glaucoma therapy may not achieve optimum visual outcome, despite a clear graft. Whereas a graft can usually repeated, if the optic nerve is damaged from end-stage glaucoma, useful vision can not be restored.

Keywords: cornea: clinical science