Corneal graft survival and intraocular pressure control after penetrating keratoplasty and glaucoma drainage device implantation.
OBJECTIVE
To investigate corneal graft survival rates and intraocular pressure (IOP) control in eyes after penetrating keratoplasty (PK) and glaucoma drainage device (GDD) implantation.


METHODS
Retrospective, comparative, consecutive case series.


METHODS
All patients who underwent PK and GDD implantation at the Bascom Palmer Eye Institute between January 1, 1993 and October 31, 1998.


METHODS
Graft clarity and IOP control.


RESULTS
Of the 72 eyes in 72 patients identified, 47 (65%) underwent combined PK and GDD implantation, and 25 (35%) underwent GDD placement after PK (2-30 months after PK; median, 13 months). The GDD type was Baerveldt 350 mm(2) in 57 eyes, Ahmed in 9, Krupin in 2, and other in 4 eyes. The GDD was placed in the anterior chamber in 54 eyes (75%) and in the vitreous cavity in 18 eyes (25%). Preoperative IOP was 11 to 53 mmHg with or without antiglaucoma medications in 16 eyes (30%) with the GDD implanted in the anterior chamber and in 4 eyes (22%) with the GDD placed in the vitreous cavity (P = 0.76). At 1 year after GDD implantation, the graft was clear in 26 eyes (48%) with the GDD in the anterior chamber compared with 15 eyes (83%) with the GDD in the vitreous cavity (P = 0.013). Forty-eight eyes (89%) with the GDD in the anterior chamber and 18 eyes (100%) with the GDD in the vitreous cavity had IOP between 5 and 21 mmHg with or without antiglaucoma medications (P = 0.33). The mean reduction in IOP, 1 year after surgery, was 12 mmHg among eyes with the GDD in the anterior chamber, compared with 17 mmHg among eyes with the GDD in the vitreous cavity (P = 0.13)


CONCLUSIONS
Corneal graft survival at 1 year is significantly higher among eyes with the GDD implanted in the vitreous cavity compared with those in which the GDD is implanted in the anterior chamber. The IOP was significantly lower at 1 year after surgery compared with before surgery in both groups, and there was no significant difference between the groups in IOP control and amount of IOP reduction. There was no significant difference in corneal graft survival or IOP control between eyes with the GDD implanted concurrently with the PK versus after the PK.
Arroyave
C P
CP
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.
Scott
I U
IU
Fantes
F E
FE
Feuer
W J
WJ
Murray
T G
TG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000601:surgery; D003315:Cornea / Q000502:physiology*; D003316:Corneal Diseases / Q000150:complications / Q000601:surgery; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000601:surgery; D020327:Glaucoma Drainage Implants; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D015948:Keratoplasty, Penetrating / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000601:surgery