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Glaucoma may increase risk of graft failure after PK
Am J Ophthalmol. 2011;151(2):257-262.
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Glaucoma may elevate the risk for graft failure among patients who undergo penetrating keratoplasty, a study found.
"This study also shows that modality of glaucoma management influences graft survival," the study authors said. "Graft survival rates for patients whose glaucoma was managed by medical therapy alone were higher than in those whose underwent glaucoma surgery."
The retrospective cohort study included 1,994 eyes with glaucoma and 6,255 eyes without glaucoma that had at least 1 year of follow-up after PK.
The relative risks of graft failure for patients who underwent PK for pseudophakic bullous keratopathy or Fuchs' dystrophy were higher for glaucoma patients on topical medications and oral medications compared with patients without glaucoma, according to the study.
In addition, endothelial decompensation caused a greater percentage of graft failures in glaucoma patients on topical glaucoma medications (9%) and oral glaucoma medications (13%) compared with those without glaucoma (3%; P < .001).
The 3-year transplant survival was 73% in patients with medically managed glaucoma and 63% in patients with surgically managed glaucoma. Patients without glaucoma had a transplant survival of 86% (P < .0001).
Postoperative best corrected visual acuity was significantly worse in glaucoma patients, especially in eyes being treated with oral medication.
Of the glaucoma patients, 41% underwent PK for pseudophakic or aphakic bullous keratopathy compared with 18% of non-glaucoma patients (P < .0001).
Significantly more patients without glaucoma underwent PK for keratoconus and Fuchs' dystrophy (P < .0001). However, no significant difference in graft failure risk was observed in patients with keratoconus, previous non-cataract ocular surgery, trauma or noninfectious ulcerative keratitis.
"Although glaucoma is a risk factor for graft failure, the mechanism is not clear and it may not ... be attributable to elevated intraocular pressure alone," the authors said.