How is penetrating keratoplasty and glaucoma (PKPG) prevented?

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

Preexisting glaucoma is frequently more difficult to treat after keratoplasty in both aphakic and pseudophakic eyes. [9]  Preexisting glaucoma has also been determined to be a risk factor for graft failure in multiple studies, including the 10-year Cornea Donor Study. [82, 86]  Reinhard and colleagues [82]  estimated the 3-year graft survival rate in patients with a preoperative history of glaucoma to be 71% in contrast to 89% in patients without such a history. Some studies suggest a higher incidence of graft failure after glaucoma operation performed after PKP. [66]  Hence, in this patient population, it is recommended that the glaucoma operation either precede or be combined with PKP. Clinicians should also be aware that certain indications for transplantation (particularly bullous keratopathy and corneal perforation) are associated with higher risk of developing PKPG.

During penetrating keratoplasty (PKP), measures such as using an oversized donor button (0.5 mm), deep bites, goniosynechialysis in the presence of peripheral anterior synechiae, iridoplasty (iris-tightening procedure) in cases of a floppy iris, removal of viscoelastic material at the end of the operation, and careful wound closure to prevent postoperative wound leaks are useful in reducing the incidence of postoperative glaucoma.

In the postoperative phase, judicious use of steroids controls the inflammation and prevents peripheral anterior synechiae. Cycloplegics (when indicated) keep the pupil mobile and prevent pupillary block glaucoma. 


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