What is penetrating keratoplasty and glaucoma (PKPG)?

Updated: Dec 30, 2020
  • Author: Shibandri Das, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Corneal transplant is the most frequently performed type of transplantation worldwide [1]  Corneal transplant is a surgical procedure that involves replacing part of the transparent tissue (cornea) at the front of the eye with healthy donor cornea tissue. Conventional corneal transplant is also called penetrating keratoplasty (PKP). Some other common procedures for corneal transplant include Descemet membrane endothelial keratoplasty and Descemet stripping automated endothelial keratoplasty.

Glaucoma is defined as a longstanding progressive optic neuropathy in which characteristic changes in the optic nerve and retinal nerve fiber layer can be observed in the absence of other eye diseases or birth anomalies. [2]  

Graft rejection and secondary glaucoma development are the 2 leading causes of graft failure after PKP. [3]  Thus, the management of penetrating keratoplasty and glaucoma (PKPG) remains controversial mainly because of the high risk for graft failure associated with the treatment.

This article addresses the history, incidence, etiology, pathophysiology, presentation, diagnosis, and treatment of glaucoma after PKP. Glaucoma after corneal transplantation is a leading cause of eye loss (ocular morbidity). [3]  A history of preexisting glaucoma can further increase the risk for elevated intraocular pressure (IOP) after PKP, which can lead to optic nerve damage and irreversible vision loss. Therefore, managing glaucoma to prevent graft rejection is extremely important because studies have indicated that there is likely only 1 available donor per 70 patients whose vision would benefit from corneal transplantation. [1]  

The risks of developing PKPG are discussed with the patient before PKP is performed. Unfortunately, because the causes and incidence of PKPG are so widely variable, an exact statistical chance of occurrence cannot be provided to patients.

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