Abstract
Purpose::
To compare the intraocular pressure outcome and cornea graft survival in patients with post-keratoplasty glaucoma who had undergone trabeculectomy, glaucoma drainage device surgery or diode transscleral cyclophotocoagulation.
Methods::
A retrospective review of clinical records of patients with refractory post-keratoplasty glaucoma that required glaucoma surgery was conducted. The patients underwent surgery at the Singapore National Eye Centre from July 1991 to September 2004. Two primary outcomes were evaluated: intraocular pressure control and graft status. In terms of intraocular pressure control, success was defined as IOP of between 6 to 21 mm Hg with and without medication and failure was defined as IOP > 21 mm Hg or < 6 mm Hg, loss of light perception or requiring further glaucoma surgery. Corneal graft failure was diagnosed by persisent stromal edema lasting beyond 1 month of intense steroid therapy, or the development of vascularisation or scarring of the graft.
Results::
70 eyes of 68 patients were analysed. The mean age was 53.5 years. There were 52 males and 16 females. Mean follow-up time was 66.1 months. The number of eyes with trabeculectomy, glaucoma drainage device and diode transscleral cyclophotocoagulation were 42, 15 and 13 respectively. There were no differences between the 3 groups in terms of age, gender, race or pre-existing glaucoma. Kaplan Maier analysis showed that trabeculectomy had both better intraocular pressure outcome (p=0.042) and graft survival (p=0.022) than glaucoma drainage device and diode transscleral cyclophotocoagulation.
Conclusions::
Trabeculectomy was found to be superior to glaucoma drainage device and diode transscleral cyclophotocoagulation in terms of both IOP control and graft survival for the surgical management of refractory post-keratoplasty glaucoma.
Keywords: intraocular pressure