Corneal Endothelial Keratoplasty After Glaucoma Treatment

IF 3.3 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2026-09-01 Epub Date: 2026-02-24 DOI:10.1016/j.ogla.2026.02.001

Sila B. Bal MD, MPH, Alexander Ivanov MS, William Kearney MS, Eric A. Goldberg MS, Connor Ross BS, Nazlee Zebardast MD, Teresa C. Chen MD, David S. Friedman MD, PhD, Roberto Pineda MD, Alice C. Lorch MD, MPH, Joan Miller MD, John H. Kempen MD, PhD

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Abstract

Purpose

To evaluate the impact of various glaucoma treatments on the incidence of corneal endothelial decompensation requiring corneal endothelial transplantation (CET) and to identify predictive factors for CET in patients with glaucoma or glaucoma suspect status.

Design

A retrospective registry-based cohort study using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).

Participants

Adults diagnosed with glaucoma or glaucoma suspect status with or without intraocular pressure (IOP)-lowering interventions. Individuals with pre-existing corneal pathology or penetrating trauma were excluded.

Methods

Demographic and clinic data were extracted for each participant-eye from January 1, 2013, to April 14, 2023, using International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification, and Current Procedural Terminology codes. The eligible cohort was followed forward in time for endothelial keratoplasty incidence. Survival analysis and multivariate Cox proportional hazards regression models were employed to estimate CET incidence and assess predictive factors for CET, defined as partial-thickness lamellar transplantation due to endothelial decompensation.

Main Outcome Measures

Incidence of CET used as an indicator of corneal endothelial decompensation.

Results

Among 7 827 337 eligible participants (42% men), glaucoma surgery was documented in 615 907 individuals. Overall, 8141 patients (0.13%) underwent CET (incidence rate: 0.03% per person-year). Within the subset undergoing glaucoma surgery, 27 513 (0.4%) had trabeculectomy, and 42 835 (0.5%) had tube or shunt surgery as their initial intervention. Compared to untreated eyes, the risk of subsequent CET was significantly increased after tube/shunt surgery (adjusted hazard ratio [aHR]: 6.63; 95% confidence interval [CI]: 5.93–7.41), trabeculectomy (aHR: 3.06; 95% CI: 2.62–3.59), and IOP-lowering drops (aHR: 1.15; 95% CI: 1.06–1.24). Conversely, minimally invasive glaucoma surgery (MIGS) (aHR: 0.80; 95% CI: 0.68–0.95) and laser trabeculoplasty (aHR: 0.70; 95% CI: 0.63–0.78) were associated with significantly decreased CET risk.

Conclusions

This large study highlights the substantially elevated risk of endothelial keratoplasty after traditional glaucoma surgeries such as tube/shunt implantation and trabeculectomy as well as the modestly increased risk associated with chronic topical glaucoma therapy. Conversely, MIGS and laser trabeculoplasty were associated with no increase in CET, and possibly even a protective effect on corneal endothelial health. These findings underscore the importance of selecting glaucoma treatments that optimize IOP control while preserving corneal endothelial integrity.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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青光眼治疗后角膜内皮角膜移植术：美国眼科学会IRIS®注册（视力智能研究）分析。

目的：评价不同青光眼治疗方法对角膜内皮失代偿需要角膜内皮移植（CET）发生率的影响，并探讨青光眼或疑似青光眼患者角膜内皮失代偿的预测因素。设计：采用美国眼科学会IRIS®注册表（视力智能研究）进行回顾性登记队列研究。参与者：诊断为青光眼或疑似青光眼的成年人，有或没有降低眼压（IOP）的干预。排除已有角膜病变或穿透性创伤的个体。方法：采用ICD-9-CM/ICD-10-CM和CPT编码提取2013年1月1日至2023年4月14日每位参与者眼的人口学和临床资料。对符合条件的队列进行随访，及时观察内皮角膜移植的发生率。采用生存分析和多变量Cox比例风险回归模型来估计CET发病率和评估CET的预测因素，CET被定义为由于内皮失代偿导致的部分厚度板层移植。主要结局指标：CET发生率作为角膜内皮失代偿的指标。结果：在7827337名符合条件的参与者中（42%为男性），615907人接受了青光眼手术。总体而言，8141例（0.13%）患者接受了CET（发病率：0.03% /人年）。在接受青光眼手术的亚组中，27,513例（0.4%）行小梁切除术，42,835例（0.5%）行导管或分流手术作为初始干预。与未经治疗的眼睛相比，管/分流手术（校正风险比[aHR]: 6.63; 95% CI: 5.93-7.41）、小梁切除术（aHR: 3.06; 95% CI: 2.62-3.59）和降眼压滴注（aHR: 1.15; 95% CI: 1.06-1.24）后，继发CET的风险显著增加。相反，微创青光眼手术（aHR: 0.80; 95% CI: 0.68-0.95）和激光小梁成形术（aHR: 0.70; 95% CI: 0.63-0.78）与CET风险显著降低相关。结论：这项大型研究强调了传统青光眼手术（如导管/分流器植入和小梁切除术）后内皮角膜移植术的风险显著增加，以及慢性局部青光眼治疗的风险适度增加。相反，微创青光眼手术和激光小梁成形术与CET没有增加相关，甚至可能对角膜内皮健康有保护作用。这些发现强调了选择在保持角膜内皮完整性的同时优化IOP控制的青光眼治疗的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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