Incidence and Prognostic Factors for Glaucoma Progression after Corneal Transplantation in Patients with Pre-existing Glaucoma

Abstract

Purpose : To assess the incidence and prognostic factors for glaucoma progression within 1-2 years following corneal transplant surgery.

Methods : Retrospective longitudinal analysis of consecutive patients with glaucoma undergoing penetrating keratoplasty (PK), Descemet stripping endothelial keratoplasty (DSEK), DSEK under previous PK, Descemet membrane endothelial keratoplasty (DMEK), or Boston keratoprosthesis I (KPro) implantation from April 2016 to December 2017 at one institution with at least 1 year of follow up. Eyes with retinal and neuro-ophthalmic pathologies were excluded. One eye per patient was included. Glaucoma was defined by a cup to disc ratio (CDR) ≥0.6, CDR asymmetry of >0.2, history of glaucoma surgery or documented diagnosis of glaucoma and was not based on intraocular pressure (IOP) or use of glaucoma medication alone. Primary outcome measure was to assess for cumulative incidence of glaucoma progression post-transplant, which was defined as CDR progression by ≥0.2 or need for glaucoma surgery; and was not based on visual field due to lack of reliable tests for all subjects. Prognostic factors for glaucoma progression were also assessed.

Results : 74 eyes of 74 patients undergoing PK (21), DSEK (26), DSEK under previous PK (10), DMEK (8), KPro (9) with a mean follow-up of 23.9 months (12.3-33.2 months) were analyzed. The incidence of glaucoma progression over first year post surgery was 20.3% overall; by procedure, 14.3% (PK), 27% (DSEK), 0% (DSEK under previous PK), 12.5% (DMEK), and 44.4% (KPro) Figure 1. At 2 years of follow-up, 10.8% of all patients progressed by CDR and 20.3% needed additional glaucoma surgery. Multiple logistic regression showed that KPro surgery, age at surgery, average IOP and average glaucoma medications over follow-up were independently associated with glaucoma progression (p<0.03 for all, Table 1), while gender, ethnicity and additional intra operative anterior or posterior vitrectomy were not (p>0.5 for all).

Conclusions : A significant proportion of glaucoma patients undergoing corneal transplantation show glaucoma progression within 1 year of having surgery. Older patients and patients undergoing KPro implantation are at the highest risk. Average follow-up IOP and glaucoma medications had a marked influence on glaucoma progression and should be carefully managed.

This is a 2021 ARVO Annual Meeting abstract.