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.