Glaucoma and Corneal Transplant Procedures

Abstract

Glaucoma after corneal transplantation is a leading cause of ocular morbidity after penetrating keratoplasty. The incidence reported is highly variable and a number of etiologic factors have been identified. A number of treatment options are available; surgical intervention for IOP control is associated with a high incidence of graft failure. IOP elevation is less frequently seen following deep anterior lamellar keratoplasty. Descemet's striping-automated endothelial keratoplasty is also associated with postprocedure intraocular pressure elevation and secondary glaucoma and presents unique surgical challenges in patients with preexisting glaucoma surgeries. Glaucoma exists in up to three-quarters of patients who undergo keratoprosthesis surgery and the management if often challenging. The aim of this paper is to highlight the incidence, etiology, and management of glaucoma following different corneal transplant procedures. It also focuses on the challenges in the diagnosis of glaucoma and intraocular pressure monitoring in this group of patients.

Three-dimensional arrangement of elastic fibers in the human corneal stroma

“…On the other hand, in penetrating keratoplasty (and other types of surgery), the elastic fiber system would be severed and the tension in the system released. The accompanying elastic recoil has potential to directly affect the peripheral cornea, the limbus, and the beams and their associated cells in the trabecular meshwork, leading to distortion of the angle, to closing of trabecular outflow channels and, in the longer term, even to glaucoma, which has long been recognised as a possible outcome of penetrating keratoplasty (see review by Al-Mahmood et al. (2012) ).…”

Long Non-Coding RNA-MALAT1 Mediates Retinal Ganglion Cell Apoptosis Through the PI3K/Akt Signaling Pathway in Rats with Glaucoma

“…According to medical studies of glaucoma, high IOP or retinal ischemia leads to constant RGC apoptosis [4, 5]. The present treatments for glaucoma are still aimed at reducing IOP, and while these treatments control IOP, they fail to prevent the progressive visual field loss of many glaucoma patients; surgical intervention for IOP control is also associated with a high incidence of graft failure [6, 7]. For that reason, the search for other glaucoma treatment modalities is a very active research field.…”

Assessment of Glaucomatous Damage After Boston Keratoprosthesis Implantation Based on Digital Planimetric Quantification of Visual Fields and Optic Nerve Head Imaging

“…1 The pathophysiology of glaucoma progression and development in KPro patients is complex and multifactorial. 2–8 Several conditions that lead patients to eventually require a keratoprosthesis are also independently associated with the development of glaucoma as evidenced by the rates of glaucoma in the following conditions: chemical burns (prevalence 22–55%), aniridia (incidence 6–75%, with prevalence as high as 91%), and penetrating keratoplasty (incidence 9–31% in the early post-operative period, 18–35% in the late post-operative period). 2 Furthermore, glaucoma is particularly challenging to diagnose, monitor, and treat in KPro patients.…”

“…corticosteroid use, inflammation, or mechanical compromise of the iridocorneal angle) may also increase the risk of glaucoma. 2–8…”