Our Summary

This study looks at how different types of corneal transplant surgeries affect glaucoma patients who had previous glaucoma surgery and are now suffering from significant corneal damage. The researchers followed 40 patients for two years after their corneal transplant surgery.

Three types of corneal transplant surgeries were performed: Descemet Membrane Endothelial Keratoplasty (DMEK), Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK), and penetrating keratoplasty (pKPL). The goal was to see if these surgeries could improve the patients’ vision and reduce their discomfort.

The results showed that 60% of patients experienced an improvement in their vision by at least two lines on the eye chart. All of the patients remained pain-free during the two-year follow-up period. The pressure inside the eye, which is a key factor in glaucoma, did not show any significant changes after the surgery.

However, the density of cells in the transplanted cornea decreased significantly over the two-year period. This is a potential concern as it could impact the long-term success of the transplant. In addition, about 22.5% of the patients experienced a failure of their transplant, which required another corneal transplant surgery. Despite this, the researchers concluded that these types of corneal transplant surgeries, particularly DMEK and pKPL, show promising results for patients who have had previous glaucoma surgery.

FAQs

  1. What is the impact of glaucoma on the success of corneal transplants?
  2. What were the results of the study on keratoplasty in glaucoma patients?
  3. What is the rate of transplant failure and re-keratoplasty in glaucoma patients who have undergone keratoplasty?

Doctor’s Tip

A helpful tip a doctor might tell a patient about corneal transplant is to closely monitor their intraocular pressure, especially if they have a history of glaucoma. High intraocular pressure can increase the risk of endothelial failure and graft rejection. Regular follow-up appointments with an ophthalmologist to monitor pressure and overall eye health are important for long-term success of the corneal transplant.

Suitable For

Patients who are typically recommended for corneal transplant include those with advanced corneal decompensation after glaucoma surgery, especially those who have had previous antiglaucoma operations. In this study, patients with previous glaucoma surgery showed satisfying results after keratoplasty, particularly with Descemet Membrane Endothelial Keratoplasty (DMEK) and penetrating keratoplasty (pKPL). Visual acuity improved in a significant number of eyes after keratoplasty, and the majority of patients remained pain-free during the follow-up period. However, some patients may experience therapy-resistant corneal decompensation and may require re-keratoplasty. It is important for patients with advanced corneal decompensation after glaucoma surgery to be evaluated by a specialist to determine if they are suitable candidates for corneal transplant.

Timeline

Before corneal transplant:

  • Patient experiences advanced corneal decompensation after previous glaucoma surgery
  • Visual acuity may be significantly impaired
  • Patient may experience pain in the eye
  • Intraocular pressure may be elevated
  • Endothelial cell density of the cornea may be low

After corneal transplant:

  • Patient undergoes keratoplasty (DMEK, DSAEK, or pKPL)
  • Visual acuity improves in many cases
  • Patient remains pain free
  • Intraocular pressure remains stable
  • Endothelial cell density of the donor cornea decreases over time
  • Some patients may experience transplant failure and require re-keratoplasty

Overall, eyes with previous glaucoma surgery show satisfying results after corneal transplant, particularly with DMEK and pKPL procedures.

What to Ask Your Doctor

  1. What are the different types of keratoplasty options available for treating corneal decompensation after glaucoma surgery?
  2. What are the potential risks and complications associated with each type of keratoplasty procedure?
  3. How long is the recovery time after keratoplasty surgery?
  4. What is the expected outcome in terms of visual acuity improvement after keratoplasty?
  5. How often will I need to follow up with the doctor after the surgery?
  6. What are the potential long-term effects on intraocular pressure after keratoplasty?
  7. How likely is it that I will need a re-keratoplasty in the future?
  8. How does previous glaucoma surgery impact the success rate of keratoplasty procedures?
  9. What is the expected decrease in endothelial cell density of the donor cornea after keratoplasty?
  10. Are there any specific precautions or lifestyle changes I need to make after keratoplasty surgery to ensure the best possible outcome?

Reference

Authors: Fili S, Kontopoulou K, Bechrakis N, Kohlhaas M. Journal: Int Ophthalmol. 2021 Oct;41(10):3387-3399. doi: 10.1007/s10792-021-01902-1. Epub 2021 May 26. PMID: 34036475