Trends in the management of new onset post- keratoplasty glaucoma: A systematic review

Rana Khalil, Conor C. Murphy

Meeting:  2022 RANZCO


Date:      -

Session Title: GLAUCOMA

Session Time:      -

Purpose: Glaucoma is the second leading cause of corneal graft failure after graft rejection. Sustained elevations in intraocular pressure can lead to graft decompensation, failure and vision loss. One of the most well-described risk factors for developing post- keratoplasty glaucoma is pre-operative glaucoma diagnosis. However, there is a paucity of data in the literature on the incidence and surgical outcomes of new-onset post-keratoplasty glaucoma.

Method: A MEDLINE Ovid search was conducted with various combinations of relevant key words. Main inclusion criteria were adults with no previous glaucoma history undergoing keratoplasty, and minimum 6 months follow- up. Exclusion criteria included paediatric cases, pre-existing or concomitant glaucoma diagnosis, and lack of clear documentation regarding pre-operative glaucoma status. Fifty- one eligible full-text articles were identified, and 11 included in the final analysis, for a total of 1809 eyes.

Results: Direct comparison between studies was not possi- ble. A descriptive analysis is presented instead. The average age of new onset post-keratoplasty glaucoma was 60 years. The pooled incidence of new onset glaucoma was 24.4%. The pooled mean rates of endothelial graft failure was 28.7%. 51.53% of eyes received both medical and surgical intraocular pressure-lowering treatment, 47.85% medical treatment alone and 0.61% surgical treatment alone.

Conclusion: There does not seem to be a significant difference in the incidence, management, or outcome of those with medically treated pre-existing glaucoma undergoing keratoplasty compared to those without a prior history of glaucoma. Differences may start to arise when one compares those with a history of glaucoma surgery prior to keratoplasty to those without. Further comparative studies are needed.