Surgical Management of Glaucoma after Keratoplasty: Comparison of Trabeculectomy and Ahmed Glaucoma Valve Implantation Outcomes

Purpose: To evaluate the visual results, intraocular pressure (IOP), use of antiglaucomatous medications, corneal graft survival rates, and complications after trabeculectomy and Ahmed glaucoma valve (AGV) implantation in patients with a history of keratoplasty (KP). Methods: A comprehensive analysis was conducted on all patient records from the Akdeniz University Medical Faculty Ophthalmology Department who had glaucoma surgery after KP between 2014 and 2022. This corresponds to a total of 49 eyes of 49 patients. Results: The mean visual acuity after AGV implantation was 1.9 ± 1.13 logMAR; in the trabeculectomy group, it was 1.2 ± 0.82 logMAR ( P = 0.028). The mean IOP levels 6 months after AGV implantation was 15.9 ± 5.02 mmHg , and in the trabeculectomy group, it was 13.8 ± 3.43 mmHg ( P = 0.170). The mean IOP levels at the patients’ last visits in the AGV implantation group was 14.3 ± 3.93 mmHg, and in the trabeculectomy group, it was 13.7 ± 3.32 mmHg ( P = 0.983). While the average number of antiglaucomatous drugs used by the patients before the glaucoma surgery in the AGV group was 3.5 ± 0.69, it was 3.6 ± 0.82 in the trabeculectomy group. In the AGV group, patients used an average of 1 ± 1.03 antiglaucomatous drugs after surgery, whereas in the trabeculectomy group, it was 0.7 ± 0.97. Graft failure was statistically significantly more common in the AGV group (9 patients [45%] in the AGV group and 5 patients [17.2%] in the trabeculectomy group) ( P = 0.0497). Conclusions: Both AGV and trabeculectomy resulted in comparable postoperative IOP levels. However, the trabeculectomy group demonstrated better visual acuity and higher corneal graft survival rates. Given these findings, trabeculectomy could be a favorable choice for glaucoma patients following KP, even considering the potential risk of postoperative hypotony. Ultimately, the treatment decision should be individualized based on each patient’s specific circumstances and needs.