Corneal Graft Survival Outcomes After Glaucoma Surgery and Medical Treatment

PURPOSE: To evaluate the association between corneal graft survival and glaucoma surgical procedures and medical treatment in eyes with postkeratoplasty glaucoma. METHODS: This retrospective study involved 1149 eyes that underwent penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty between 2004 and 2019. They were divided into 5 groups according to the types of glaucoma treatment after keratoplasty: trabeculotomy (TLO), trabeculectomy (TLE), glaucoma drainage device, topical antiglaucoma drugs alone, and no glaucoma treatment. Eyes with trauma, infection, or rejection during the follow-up period, and those that other types of glaucoma surgery, were excluded. Graft survival and risk factors for graft failure after glaucoma treatment were analyzed using Kaplan-Meier survival analysis and the Cox proportional hazards model. RESULTS: The cumulative probability of graft survival at 3 years postoperatively was 87.3% in the TLO group, 58.2% in the TLE group, 68.6% in the glaucoma drainage device group, 89.1% in the topical medication group, and 96.6% in the no-treatment group (P < 0.001, log-rank test). The presence of bleb before keratoplasty [hazard ratio (HR) 3.34; 95% confidence interval (CI) 1.94-5.37; P < 0.001] and failure of intraocular pressure control after glaucoma treatment (HR 4.11; 95% CI 2.15-7.86; P < 0.001) were major risk factors for graft failure, whereas TLO was associated with a significantly lower risk of graft failure compared with TLE (HR 4.57; 95% CI 1.19-17.47; P = 0.03). CONCLUSIONS: Our findings showed that TLO is associated with a lower risk of graft failure compared with TLE. Outflow facility reconstruction procedures, such as TLO, seem to be effective first-line surgical options for postkeratoplasty glaucoma.