Glaucoma and corneal transplantation

Cheryl Guttman Krader

Posted: Monday, October 1, 2018

OCULAR hypertension and glaucoma increase the risk for graft failure. Therefore, it is important that corneal transplantation patients be monitored carefully for these complications and be treated early and aggressively should they occur, said Elena Arrondo MD, during a discussion on glaucoma and ocular surface at the 9th EuCornea Congress.

Dr Arrondo, Instituto de Microcirugia Ocular, Barcelona, Spain, noted that compared with eyes that have undergone a partial thickness procedure, the risk for glaucoma is higher in eyes with a penetrating keratoplasty or a Boston keratoprosthesis.

Nevertheless, the potential for ocular hypertension and glaucoma development after deep anterior lamellar keratoplasty or an endothelial keratoplasty procedure should not be overlooked.

In addition, the risk of glaucoma varies depending on the reason for the graft, and it is particularly high in eyes with previous glaucoma, aphakia, or pseudophakic bullous keratopathy.

Discussing medical treatment, Dr Arrondo said that beta-blockers, alpha2 agonists, and systemic carbonic anhydrase inhibitors may be used. On the other hand, anticholinergics, prostaglandin analogs, and topical carbonic anhydrase inhibitors should be avoided because they increase the risk of graft failure from rejection, endothelial failure or ocular surface disease.

Dr Arrondo said there is limited information on laser trabeculoplasty to treat ocular hypertension/glaucoma after corneal transplantation, in part because it is difficult to perform in eyes with a corneal graft.

She presented a decision-making algorithm for choosing surgical intervention that takes into account visual acuity in the affected and fellow eyes, the condition of the conjunctiva, angle status and the absence/presence of silicone oil in the eye.

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