Glaucoma Drainage Devices and Reasons For Keratoplasty

Abstract

Précis: Over 10 years in a tertiary care setting, glaucoma drainage devices (GDDs) have not increased as a reason for keratoplasty. Purpose: The purpose of this study was to determine whether the reasons for keratoplasty have changed between 10 years in a tertiary care setting, with special attention to the rate of GDDs as a reason for keratoplasty. Methods: Patients aged 18 years or above who underwent keratoplasty at Mayo Clinic, Rochester, MN from 2005 to 2006 and 2015 to 2016 were studied. All reasons for keratoplasty performed in the study time period are assessed, including patients who previously had a GDD implanted in the same eye. After analyzing the reasons for keratoplasty, we assess whether the reasons for keratoplasty have changed between 2005 to 2006 and 2015 to 2016 in association with the increasing placement of GDDs. Results: The number of keratoplasty procedures performed in the 2 time periods increased by 62% from 163 (2005 to 2006) to 264 (2015 to 2016), whereas GDD placement increased by 164% from 80 GDD (2005 to 2006) to 211 GDD (2015 to 2016). Although the performance of keratoplasty increased between the 2 points in time, the frequency of each cause for keratoplasty did not change significantly. The majority of keratoplasties were performed due to corneal disease, and GDDs made up a small portion of reasons for keratoplasty (2005 to 2006, 4.29%; 2015 to 2016, 5.68%). Conclusions: The frequency of GDDs as a reason for keratoplasty has not changed significantly between 10 years in this tertiary care setting. Patients with GDDs who later required keratoplasty had associated features including multiple surgical procedures and comorbid infection, pseudophakic bullous keratopathy, Fuchs dystrophy, pseudoexfoliation, uveitis, and congenital glaucoma.

Etiology and outcome of penetrating keratoplasty in bullous keratopathy post-cataract surgery vs post-glaucoma surgery

“…Third, the GBK group included the eyes that underwent cataract surgery as we defined GBK as BK following glaucoma surgery regardless of a history of cataract surgery, while we designated PBK as cases developing BK after cataract extraction and IOL implantation without history of glaucoma surgery or laser. This was inevitable because the majority of GBK patients had undergone cataract surgery in the real world, as was the case in our own case series and in other studies [22][23][24]. Thus, our results should be interpreted with caution, considering the possibility that glaucoma surgery may act as an aggravating factor in BK development rather than its isolated cause.…”

Effects of femtosecond laser‐assisted trephination on donor tissue in liquid interface as compared to applanated interface

“…L‐PI trephination prevented corneal deformation and resulted in considerably lower levels of intravitreal pressure: this may present a feasible opportunity to improve the safety of keratoplasty when using a femtosecond laser, in particular for eyes with pre‐existing diseases and risk factors such as vascular or nerve damage (Knier et al. 2019 ).…”

Clinical Factors Impacting Outcomes From Failed Trabeculectomy Leading to Glaucoma Drainage Device Implantation and Subsequent Penetrating Keratoplasty

“…17,18 However, the improper orientation of the needle while creating the track through, which the tube is passed into the anterior chamber (AC) during GDI surgery, may result in tube malpositioning, with the tube lying too close to the endothelial surface of the cornea and result in progressive endothelial cell loss, persistent corneal edema, corneal decompensation, and, in the setting of a previous PK, graft failure. 19 A meta-analysis conducted by Fang et al 20 reported that GDIs reduced endothelial cell counts by 5.75% at 12month follow-up and by 8.11% at 24-month follow-up compared with the fellow eye. In eyes that had undergone trabeculectomy, the mean rate of endothelial loss was 33 cells/ mm 2 (1.5%) at the 12-month follow-up.…”

“…GDIs are also the surgical procedure of choice in post-PK glaucoma as it has a very good IOP lowering effect, 16 and conventional filtration surgery carries a higher failure rate in eyes with a prior corneal graft 17,18 . However, the improper orientation of the needle while creating the track through, which the tube is passed into the anterior chamber (AC) during GDI surgery, may result in tube malpositioning, with the tube lying too close to the endothelial surface of the cornea and result in progressive endothelial cell loss, persistent corneal edema, corneal decompensation, and, in the setting of a previous PK, graft failure 19 . A meta-analysis conducted by Fang et al 20 reported that GDIs reduced endothelial cell counts by 5.75% at 12-month follow-up and by 8.11% at 24-month follow-up compared with the fellow eye.…”