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Incidence and risk factors for glaucoma development and progression after corneal transplantation

Eye volume 37, pages 2117–2125 (2023)Cite this article

Subjects

Abstract

Objective

To assess the cumulative incidence and risk factors for glaucoma development and progression within 1-2 years following corneal transplant surgery.

Design

Retrospective cohort study.

Methods

Patients undergoing penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet stripping endothelial keratoplasty (DSEK), Descemet membrane endothelial keratoplasty (DMEK), Boston keratoprosthesis type I (KPro) implantation, or endothelial keratoplasty (DSEK or DMEK) under previous PK (EK under previous PK) at one academic institution with at least 1 year of follow-up were included. Primary outcome measures were cumulative incidence of glaucoma development and progression after corneal transplant, in patients without and with preoperative glaucoma, respectively. Risk factors for glaucoma development and progression were also assessed.

Results

Four hundred and thirty-one eyes of 431 patients undergoing PK (113), DALK (17), DSEK (71), DMEK (168), KPro (35) and EK under previous PK (27) with a mean follow-up of 22.9 months were analyzed. The 1-year cumulative incidence for glaucoma development and progression was 28.0% and 17.8% in patients without and with preoperative glaucoma, respectively. In a Cox proportional hazards analysis, DSEK surgery, KPro implantation, average intraocular pressure (IOP) through follow-up and postoperative IOP spikes of ≥30 mmHg were each independently associated with glaucoma development or progression (p < 0.04 for all).

Conclusions

A significant proportion of patients developed glaucoma or exhibited glaucoma progression within 1 year after corneal transplantation. Patient selection for DSEK may partly explain the higher risk for glaucoma in these patients. Postoperative IOP spikes should be minimized and may indicate the need for co-management with a glaucoma specialist.

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Fig. 1: Incidence of glaucoma development and glaucoma progression in corneal transplant patients without and with preoperative glaucoma, respectively.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Boston Keratoprosthesis Fund, Massachusetts Eye and Ear, Boston, MA.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Chhavi Saini, Emma C. Davies, Lawson Ung, James Chodosh, Joseph B. Ciolino, Ula V. Jurkunas, Eleftherios I. Paschalis, Roberto Pineda, Hajirah N. Saeed, Jia Yin & Lucy Q. Shen

  2. Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Eleftherios I. Paschalis & Jia Yin

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  1. Chhavi Saini
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Contributions

CS: Conceptualization, methodology, formal analysis, investigation, data curation, writing- original draft, visualization. ECD: Conceptualization, methodology, investigation, resources, writing- review & editing. LU: Conceptualization, methodology, formal analysis, writing- review & editing. JC: Conceptualization, methodology, investigation, resources, writing- review & editing, supervision, funding acquisition. JBC: Conceptualization, methodology, investigation, resources, writing- review & editing. UVJ: Conceptualization, methodology, investigation, resources, writing- review & editing. EIP: Conceptualization, methodology, investigation, resources, writing- review & editing. RP: Conceptualization, methodology, investigation, resources, writing- review & editing. HNS: Conceptualization, methodology, investigation, resources, writing- review & editing. JY: Conceptualization, methodology, investigation, resources, writing- review & editing. LQS: Conceptualization, methodology, investigation, resources, writing- original draft, supervision, project administration, funding acquisition.

Corresponding author

Correspondence to Lucy Q. Shen.

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Competing interests

CS is supported by the Boston Keratoprosthesis Fund, Massachusetts Eye and Ear, Boston. LU is supported in part by the Dozoretz Family Private Foundation. JC is a consultant for the US Food and Drug Administration. JBC is a consultant for ORA System, TherOptix and Fontana and, has intellectual property and equity interest in TherOptix and Fontana. RP is a consultant for Sanofi Genzyme and receives royalties from Elsevier. JY is a consultant for Kera Therapeutics and has equity interest in Kera Therapeutics. LQC received research support from Topcon and is a consultant for FireCyte Therapeutics and AbbVie. ECD, EIP, and HNS declare no potential competing interests.

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Saini, C., Davies, E.C., Ung, L. et al. Incidence and risk factors for glaucoma development and progression after corneal transplantation. Eye 37, 2117–2125 (2023). https://doi.org/10.1038/s41433-022-02299-6

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