What is the best initial treatment option for 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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Answer

Controversy still exists as to which surgical procedure is the best initial treatment option in terms of graft survival, as data on prognosis are not clear. In addition, the best timing of the surgery in patients with preexisting glaucoma (ie, whether to perform the surgery before, at the same time as, or after the corneal transplant operation) is still unclear.

Some authors recommend placement of the GDD in the posterior chamber combined with vitrectomy or placement in the ciliary sulcus anterior to the lens and posterior to the iris. These authors believe that placing the tube behind the iris diaphragm decreases the risk for graft failure.

Similarly, diode laser cycloablation is believed to result in less inflammation and more precise ciliary process destruction; however, definitive evidence is still lacking in both situations. Randomized, prospective studies are needed to determine which of the available treatment options should be the treatment of choice for patients with PKPG.


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