Keratoplasty patients require early, continual intervention for glaucoma

SARASOTA, Fla. — The careful and aggressive management of glaucoma is essential to avoid graft rejection in keratoplasty patients, said Ramesh S. Ayyala, MD, FRCS, FRCOphth, at the meeting of the American Glaucoma Society.

The incidence of glaucoma in the early postoperative period after keratoplasty ranges from 9% to 31%; in the late postoperative period, the incidence rises from 18% to 35%, according to Dr. Ayyala. These patients face complications that include hypotony, graft rejection and vision loss, he noted.

“The reason why we miss glaucoma is because we concentrate so much on the cornea,” he said.

To decrease postoperative complications and graft rejections, Dr. Ayyala suggested that glaucoma patients undergo filtering surgery before keratoplasty; bleb revision can then be performed during the corneal transplantation procedure.

In patients who develop glaucoma after keratoplasty, Dr. Ayyala noted that surgeons should follow the standard glaucoma protocol, starting with medication, then moving to laser procedures and finally more invasive surgeries.

While following keratoplasty patients, glaucoma surgeons must also account for the irregular corneal surface when performing tonometry, he said. In addition, steroids, while important for controlling ocular inflammation, should be limited to topical drugs to prevent corneal epithelial toxicity, he noted.