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Robert M. Knape, M F. Smith; Ten Year Follow Up of Eyes With Glaucoma Drainage Device and Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2644.
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To report extended follow up of eyes with glaucoma drainage devices (GDD) and penetrating keratoplasty (PK). Due to associated comorbidities and difficulty in obtaining such extensive follow up in this patient population, no published data exists for such eyes beyond approximately three years of follow up. The authors extend their follow up to assess glaucoma control and corneal graft survival in patients that completed 10 years of follow up.
IRB approved, retrospective, noncomparative review of all patients who underwent both GDD and PK between January 1, 1988 and December 31, 2000, at an academic institution. 17 eyes of 16 patients were identified. The success of the GDD and PK were assessed using Kaplan-Meier statistical analysis. Glaucoma outcome measures included comparison of intraocular pressure and the number of glaucoma medications before and during the study period, as well as need for subsequent glaucoma surgery. Corneal outcome measures included comparison of Snellen visual acuity and corneal clarity before and during the study period, as well as graft rejection, failure, and need for subsequent corneal surgery.
The mean pre-GDD intraocular pressure was 29.2 mmHg on a mean of 2.5 glaucoma medications. At 10 years follow-up, the mean IOP was 14.0 mmHg on 1.0 glaucoma medications. GDD implantation successfully controlled glaucoma in 73% of eyes at 10 years. Graft rejection occurred in 54% eyes, and graft failure occurred in 36% of eyes. Grafts remained clear in 91%, 55%, and 36% at 1, 5 and 10 years, respectively. Failure of glaucoma control was associated with prior intraocular surgeries and certain glaucoma diagnoses. Failure of the PK was also associated with prior intraocular surgeries, poor glaucoma control and certain corneal diagnoses. Complications occurred in 9% of eyes.
GDD implantation can provide glaucoma control in a high percentage of eyes with PK. The success of PK is low at 10 years (36%). This extended follow up data suggests that cornea and glaucoma outcomes may follow the survival trends noted in shorter term studies, and may be of prognostic value for counseling these complicated patients.
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