Glaucoma after penetrating keratoplasty

Glaucoma after penetrating keratoplasty remains a management problem. The incidence is significant because of the status of those eyes undergoing PKP. Many have had multiple previous surgeries, and aqueous outflow may be compromised before the PKP. The surgery itself causes additional damage to the angle, often inducing peripheral anterior synechiae formation, with further impediment to aqueous outflow. Control of postkeratoplasty glaucoma is complicated by the need to preserve graft clarity for visual function. Medical treatment with aqueous suppressants is the first line of care. Since the introduction of apraclonidine 0.5%, and with topical carbonic anhydrase inhibitors soon to be introduced, perhaps medical management will become easier. When medical management fails, if the angle is open and viable, argon laser trabeculoplasty may be an option. If further intervention is indicated, the authors recommend a drainage seton (double-plate Molteno, or Baerveldt tube) in those eyes with good visual potential. For those eyes with poor visual potential (or those patients who cannot undergo surgery), we recommend contact Nd: YAG CPC.