eMedicine Specialties > Ophthalmology > Intraocular Pressure

Glaucoma and Penetrating Keratoplasty: Follow-up

Author: Rajesh Shetty, MD, Assistant Professor of Ophthalmology, College of Medicine, Mayo Clinic; Consultant, Department of Ophthalmology, Mayo Clinic, Jacksonville
Coauthor(s): Edney de Resende Moura Filho, MD, Fellow, Department of Ophthalmology, Mayo Clinic, Jacksonville; Saiyid A Hasan, MD, Assistant Professor of Ophthalmology, College of Medicine, Mayo Clinic; Senior Associate Consultant, Education Coordinator, Department of Ophthalmology, Mayo Clinic, Jacksonville; Ramesh S Ayyala, MD, FRCS, FRCOphth, Chief, Section of Ophthalmology, Charity Hospital of New Orleans; Director of Glaucoma Services, Assistant Professor, Department of Ophthalmology, Tulane University School of Medicine
Contributor Information and Disclosures

Updated: Feb 26, 2009

Outcome and Prognosis

The surgical success rate of the 3 procedures (ie, trabeculectomy with mitomycin-C, GDD surgery, cyclodestructive procedure) in controlling the IOP to less than 21 mm Hg is similar (70-75%).

The prognosis for graft survival is less clear. The lowest incidence of graft failure follows trabeculectomy (10-20%), as compared to GDD surgery (10-50%) and cyclodestructive procedure (20-50%). Therefore, the long-term prognosis for graft survival appears to be 40-60% in patients with PKPG.

Future and Controversies

Eye care professionals should be educated to monitor the IOP in all patients following PKP. Patients with PKPG who are not responding to medications should be treated surgically.

Controversy still exists as to which of the 3 surgical procedures is the best initial treatment option in terms of graft survival. In addition, the timing of the surgery (ie, whether to perform the surgery prior to, combined with, or after the corneal transplant operation) is still not clear.

Some authors recommended placement of the GDD into the posterior chamber combined with vitrectomy or placement into 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 of 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 in the postkeratoplasty glaucoma population.

 


More on Glaucoma and Penetrating Keratoplasty

Overview: Glaucoma and Penetrating Keratoplasty
Workup: Glaucoma and Penetrating Keratoplasty
Treatment: Glaucoma and Penetrating Keratoplasty
Follow-up: Glaucoma and Penetrating Keratoplasty
References
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Further Reading

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Keywords

glaucoma and penetrating keratoplasty, penetrating keratoplasty and glaucoma, penetrating keratoplasty, corneal transplant, glaucoma, PKPG, PKP, open angle, closed angle, vision loss, visual deficit

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Contributor Information and Disclosures

Author

Rajesh Shetty, MD, Assistant Professor of Ophthalmology, College of Medicine, Mayo Clinic; Consultant, Department of Ophthalmology, Mayo Clinic, Jacksonville
Rajesh Shetty, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, American Society of Cataract and Refractive Surgery, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Edney de Resende Moura Filho, MD, Fellow, Department of Ophthalmology, Mayo Clinic, Jacksonville
Edney de Resende Moura Filho, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Saiyid A Hasan, MD, Assistant Professor of Ophthalmology, College of Medicine, Mayo Clinic; Senior Associate Consultant, Education Coordinator, Department of Ophthalmology, Mayo Clinic, Jacksonville
Saiyid A Hasan, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Ramesh S Ayyala, MD, FRCS, FRCOphth, Chief, Section of Ophthalmology, Charity Hospital of New Orleans; Director of Glaucoma Services, Assistant Professor, Department of Ophthalmology, Tulane University School of Medicine
Ramesh S Ayyala, MD, FRCS, FRCOphth is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Bradford Shingleton, MD, Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary
Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Louis E Probst, MD, Medical Director of Refractive Surgery, Chicago, Madison, Milwaukee, and Windsor Centers, TLC the Laser Eye Centers
Louis E Probst, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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