• Risk of Glaucoma Surgery After Corneal Transplantation

    Written By: Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, August 2018

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    The reported incidence of glaucoma after corneal transplantation varies greatly, as does the definition of post­transplant glaucoma. In a retrospective study, Zheng et al. used the endpoint of glaucoma surgery to represent severe cases and tallied rates for this surgery in the year following corneal transplant procedures. Although some research suggests that greater angle alteration during a corneal transplant confers higher risk for glaucoma surgery, the authors found no significant differenc­es in risk among transplant groups. As expected, the patients with preexisting glaucoma were more likely to require surgical intervention for it.

    For their study, the authors looked at a random sample of Medicare beneficiaries, identified by Current Pro­cedural Terminology codes for pene­trating keratoplasty (PK), endothelial keratoplasty (EK), anterior lamellar keratoplasty (ALK), and keratoprosthe­sis (KPro). They performed a separate analysis on the group of patients who had preexisting glaucoma. The primary endpoint was glaucoma surgery within the year following a corneal transplant.

    This 4-year study period (2010-2013) included 3,098 patients. EK was performed in 1,919, PK in 1,012, ALK in 46, and KPro in 32; while 89 patients received both PK and EK. Rates of glau­coma surgery in the first year ranged from 6.1% to 9.4%, with no significant differences between transplant groups. Surgical intervention for glaucoma was needed in 10% of patients with preexisting glaucoma, as opposed to 5.3% of those without it. The rate was highest for PK recipients with preexisting glaucoma (12.4%), a finding that surgeons should consider when selecting a cornea transplant procedure for patients with glaucoma.

    The authors emphasized the impor­tance of close monitoring for glaucoma after corneal transplants, even if angle anatomy has been preserved. Longer-term, studies are needed to determine whether the rates will change over time or will differ substantially for certain types of corneal transplants.

    The original article can be found here.