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Glaucoma Is "Devastating" Complication Of Repeated Corneal Transplantation

Pre-existing or postoperative glaucoma "is one of the most devastating complications" associated with repeated corneal transplants, say researchers.

Even with intensive treatment, glaucoma can provoke re-graft failure and visual loss.

Researchers from Western Galilee-Nahariya Medical Center, Israel, examined the charts of 80 patients that underwent 122 repeated corneal transplants. Six patients received transplants in both eyes. Mean follow-up after primary keratoplasty was 89.5 months and patients were followed for at least six months after the last transplant.

Thirty-four percent of the eyes and 35 percent of the patients that underwent repeated corneal transplants developed post-operative glaucoma. Post-operative glaucoma was especially likely to emerge in patients that underwent transplantation for a herpetic scar or who had a history of immune graft rejection. The risk of developing glaucoma was positively correlated with the number of keratoplasties.

Closed-angle glaucoma was the commonest manifestation, accounting for 59 percent of cases. Corticosteroid-induced and open angle glaucoma accounted for 21 and 11 percent of cases respectively. Angle recession, aqueous misdirection, and unknown causes each accounted for 3 percent of cases.

Sixty-two percent of patients needed surgery. In 31 percent of the eyes, regrafting or discontinuing corticosteroids controlled the glaucoma. Seventeen percent showed clear re-grafts. However, the control of intraocular pressure was better in eyes that did not need surgery. In 52 percent of the eyes, uncontrolled glaucoma or other factors lead to re-graft failure.

At the end of follow-up, 17 percent of patients showed visual acuity of between 20/30 and 20/200. Thirty-one percent of the patients could count fingers from less than 20 feet, while 35 percent could perceive hand movement or light. On the other hand, seventeen percent reported no light perception.

Seven percent of the eyes and 7.5 percent of the patients showed pre-existing glaucoma. In patients with pre-existing glaucoma, graft clarity and glaucoma control were similar to those patients with postkeratoplasty glaucoma. Half of the patients with pre-existing glaucoma showed controlled glaucoma and a third showed clear re-grafts.

The authors concluded that pre-existing or postoperative glaucoma "is one of the most devastating complications" associated with repeated corneal transplantation. Even following intensive treatment, glaucoma can provoke re-graft failure and visual loss. The authors commented that patients should be closely monitored and glaucoma treated rapidly to increase the likelihood of corneal graft survival.
Cornea 2002;21:759-765. "Preexisting and postoperative glaucoma in repeated corneal transplantation."

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