Endothelial keratoplasty: Interplay of glaucoma, corneal surgery

 

Take-home message: Endothelial keratoplasty makes it easier to follow patients with glaucoma and lowers the risk of ocular surface disease.

 

By Lynda Charters; Reviewed by Francis W. Price Jr., MD

Indianapolis-Glaucoma surgery can cause corneal decompensation and corneal transplant surgery can cause glaucoma, said Francis W. Price Jr., MD, who is in private practice in Indianapolis.

However, it is less well known that tissue-specific corneal transplants, such as endothelial keratoplasty (EK), provide a better understanding of how glaucoma surgery affects the cornea. Penetrating keratoplasty (PK) causes increases in IOP because of the use of topical steroids and changes in the angle.

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EK takes substantially fewer tolls on patients with glaucoma and lowers the risk of ocular surface disease, since filters are highly detrimental to grafts, he noted.

Dr. Price and colleagues in a study of 10-year PK survival rates found that glaucoma present before surgery resulted in double the risk of rejection failures and of endothelial failure without rejections, and tripled the risk of ocular surface disease failures (Arch Ophthalmol. 2003;121:1087-1092).

The Cornea Donor Study (Ophthalmology. 2009;116:1023-1028) reported the presence of glaucoma significantly negatively affected the 5-year PK survival, with medically managed glaucoma associated with double the risk of failure, surgically managed glaucoma triple the risk of failure, and medical and surgical management seven times the risk of failure, he noted.

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