Our Summary

Glaucoma, a disease that damages the eye’s optic nerve, is often a cause of vision loss after a cornea transplant. This disease can already be present before the transplant or can develop afterwards in up to one third of patients. The research suggests that it’s important to manage any pre-existing glaucoma before the cornea transplant surgery, either through medication or additional surgery. After the transplant, increased eye pressure can be a sign of glaucoma, and identifying any risk factors for this can help with proper management and care.

There are different types of cornea transplants, and the research highlights that patients undergoing a particular type, called anterior lamellar keratoplasty, can experience lower rates of glaucoma after their transplant surgery. However, another type of surgery, known as endothelial keratoplasty, can be complicated by glaucoma, often due to issues managing eye pressure caused by air bubbles in the front part of the eye. Even so, this type of glaucoma is generally less severe and easier to control than the one associated with another type of cornea transplant, known as penetrating keratoplasty.

The study stresses the importance of managing glaucoma effectively, whether it exists before or develops after cornea transplant surgery, to prevent permanent damage to the optic nerve and increase the likelihood of a successful transplant.

FAQs

  1. What is the relationship between glaucoma and corneal transplant?
  2. How can pre-existing glaucoma be managed before a corneal transplant surgery?
  3. How does glaucoma affect eyes with endothelial keratoplasties?

Doctor’s Tip

A helpful tip a doctor might tell a patient about corneal transplant is to be aware of the increased risk of developing glaucoma after the surgery. It is important to have regular eye exams and to closely monitor intraocular pressure to prevent vision loss and graft failure. Pre-existing glaucoma should be well-controlled before undergoing corneal transplant surgery. Additionally, patients undergoing anterior lamellar keratoplasty may have lower rates of postkeratoplasty glaucoma compared to other types of transplant procedures. Proper management of glaucoma before and after corneal transplant can help protect the optic nerve and improve graft survival.

Suitable For

Patients who are typically recommended for corneal transplant are those with conditions such as keratoconus, Fuchs’ dystrophy, corneal scarring, and corneal ulcers that cannot be effectively treated with other interventions. Additionally, patients with corneal edema, hereditary corneal dystrophies, and corneal infections may also benefit from corneal transplant surgery. Patients with pre-existing glaucoma or at risk for developing glaucoma may require special consideration and management before and after corneal transplant to optimize graft survival and visual outcomes.

Timeline

Before corneal transplant:

  1. Patient is evaluated by an ophthalmologist and diagnosed with a corneal disease that requires a transplant.
  2. Patient undergoes preoperative testing and evaluations to determine candidacy for surgery.
  3. If patient has pre-existing glaucoma, it must be controlled before surgery through medication or surgery.
  4. Patient is placed on a waiting list for a corneal donor.
  5. Once a donor is found, patient undergoes corneal transplant surgery.

After corneal transplant:

  1. Patient is monitored closely for signs of rejection or infection in the weeks following surgery.
  2. Patient may experience increased intraocular pressure, which can lead to glaucoma in up to one-third of cases.
  3. Risk factors for postkeratoplasty glaucoma are identified and managed to prevent vision loss and graft failure.
  4. Patients who undergo anterior lamellar keratoplasty may have lower rates of postkeratoplasty glaucoma.
  5. Patients with endothelial keratoplasties may experience spikes in intraocular pressure related to air bubbles in the anterior chamber, but this is more easily controlled compared to penetrating keratoplasty.
  6. Proper management of glaucoma before and after surgery is crucial to prevent optic nerve damage and increase graft survival.

What to Ask Your Doctor

  1. What are the potential risks and complications of a corneal transplant, including the risk of developing glaucoma?

  2. How will my pre-existing glaucoma be managed before and after the corneal transplant surgery?

  3. What are the signs and symptoms of increased intraocular pressure after the surgery, and how will it be monitored?

  4. What are the risk factors for developing glaucoma after a corneal transplant, and how can they be minimized?

  5. How will the management of intraocular pressure spikes related to anterior chamber air bubbles be handled after an endothelial keratoplasty?

  6. How often will I need follow-up appointments to monitor for glaucoma and other potential complications after the corneal transplant?

  7. What are the treatment options for glaucoma that may develop before or after the corneal transplant surgery?

  8. How can adequate management of glaucoma improve the chances of graft survival and prevent damage to the optic nerve?

  9. Are there any lifestyle changes or medications I should consider to help reduce the risk of developing glaucoma after the corneal transplant?

  10. What are the long-term implications of having glaucoma after a corneal transplant, and what steps can be taken to ensure optimal eye health and vision outcomes?

Reference

Authors: Abdelghany AA, D’Oria F, Alio JL. Journal: Surv Ophthalmol. 2021 Mar-Apr;66(2):276-289. doi: 10.1016/j.survophthal.2020.08.002. Epub 2020 Aug 19. PMID: 32827497