Glaucoma surgery success and corneal graft survival in patients with prior corneal transplantation: A retrospective cohort study.

Purpose: Elevated intraocular pressure (IOP) following corneal transplantation (CT) presents a significant risk for graft failure and visual impairment. This retrospective cohort study aims to evaluate the outcomes of different glaucoma surgeries and corneal graft survival rates in patients who have undergone CT.

Methods: A single-center, retrospective cohort was conducted on all patients at our tertiary hospital who had received glaucoma surgery following corneal transplant surgery from 2020 to 2023. Inclusion criteria were defined as patients over 18 years of age, with at least 6 months of follow-up. The primary outcomes included corneal graft survival and glaucoma surgery success.

Results: Twenty eyes from 18 patients who underwent glaucoma procedures after a corneal transplant were analyzed. Glaucoma surgery success - IOP level within limits (>6 mmHg but below the preset target), no further glaucoma surgeries, and no postoperative severe vision loss due to complications - was achieved in 80% of cases, with no significant differences observed among techniques. Corneal graft survival at 6 months (a functional transplant that does not require a regraft procedure and with central graft clarity) was 55%, with higher rates observed in patients undergoing nonpenetrating deep sclerectomy (NPDS), XEN45 gel stent (XGS), or PAUL glaucoma implant (PGI) procedures compared to trabeculectomy and Ahmed valve. Only 35% of patients experienced minor complications, and no major adverse events were reported.

Conclusion: In our retrospective cohort study, surgical approaches such as NPDS, XGS, or PGI showed the most favorable outcomes regarding glaucoma surgery success and corneal graft survival rates.