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B.-K. Loh, D. T. H. Tan, T. Aung; Long Term Outcomes of Glaucoma Surgery for Post-Keratoplasty Glaucoma in Asian Eyes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3953.
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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.
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.
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.
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.
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