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Glaucoma deemed ‘devastating’ in repeated corneal transplants
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NAHARIYA, Israel — Glaucoma is “one of the most devastating complications of repeated corneal transplantation” and a cause of regraft failure and visual loss even when aggressively treated, according to a review of long-term follow-up.
Researchers here reviewed the charts of all patients who underwent repeated corneal transplantations between 1985 and 1998 to identify the occurrence of existing and postoperative glaucoma. They identified 80 patients who together had undergone 122 repeated corneal transplants. Of those, six underwent surgery in both eyes. The mean follow-up after primary keratoplasty was 89.5 months, with a minimal follow-up period of at least 6 months after the last transplant.
Postoperative glaucoma affected 29 eyes of 28 patients with repeated corneal transplantation. Herpetic scar was an indication for transplantation more often and a history of previous immune graft rejection was more common in patients who developed postoperative glaucoma compared to the whole group of regrafted patients. Further, the more keratoplasties a patient underwent, the higher the incidence of glaucoma.
Of the patients who developed glaucoma, 59% had closed-angle, 21% had corticosteroid-induced, 11% had open-angle, 3% had angle-recession and 3% had aqueous misdirection glaucomas, and 3% could not be attributed to any one cause.
Surgical intervention for the treatment of glaucoma was required in 62% of cases. Better intraocular pressure control was achieved in those cases that did not require surgical intervention. Glaucoma was controlled in nine eyes and resolved following regrafting or discontinuation of corticosteroids in four eyes.
At the end of the follow-up period, visual acuity was 20/30 to 20/200 in 17% of the eyes, counting fingers from less than 20 feet away in 31%, hand movement/light perception in 35% and no light perception in 17%. Glaucoma had previously been present in six eyes of six patients. Graft clarity and glaucoma control in those patients were similar to those with postkeratoplasty glaucoma.
The study is published in Cornea.