How is penetrating keratoplasty and glaucoma (PKPG) treated?

Updated: Dec 30, 2020
  • Author: Shibandri Das, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Answer

The addition of newer classes of individual and combination drugs, novel glaucoma drug delivery systems, laser therapy, surgical procedures, glaucoma drainage devices (GDDs), and minimally invasive glaucoma surgery, have increased the options available to the clinician in the management of PKPG.

Medical management (eg, topical drops, systemic pills) continues to be first-line treatment for PKPG.

Available antiglaucoma medications include β-adrenergic blocking agents (eg, timololbetaxolol), adrenergic agents (eg, epinephrine, dipivefrin), α2-adrenergic agonists (eg, brimonidineapraclonidine hydrochloride), miotics (eg, pilocarpineechothiophate iodidecarbachol), prostaglandin analogues (eg, latanoprost), topical carbonic anhydrase inhibitors (eg, dorzolamidebrinzolamide), and systemic carbonic anhydrase inhibitors (eg, acetazolamidemethazolamidedichlorphenamide). Two novel glaucoma medications (in newer drug categories) have received US Food and Drug Administration (FDA) approval. These dual action agents include a prostaglandin and nitric oxide analogue (eg, latanoprostene bunod) and a rho kinase and norepinephrine transporter inhibitor (eg, netarsudil).

Surgical treatment may take the form of selective laser trabeculoplasty, glaucoma-filtering procedures such as trabeculectomy and implantation of a GDD, various cyclodestructive procedures, or minimally invasive glaucoma surgery. This article also briefly covers argon laser trabeculoplasty because of its historical significance. 


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