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Surgical management for postkeratoplasty glaucoma: a meta-analysis
Anika Tandon1, Ladan Espandar, David Cupp
1*Glaucoma Service, Department of Ophthalmology, Tulane University, New Orleans, LA †Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, MA.
Journal of Glaucoma
|December 11, 2012
Summary
This meta-analysis compared glaucoma surgeries after corneal transplants. Glaucoma drainage devices (GDD) offered better intraocular pressure (IOP) control and lower failure rates but increased graft failure risk.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Corneal Transplantation
Background:
- Postkeratoplasty glaucoma is a significant complication following corneal transplantation.
- Effective management of intraocular pressure (IOP) is crucial for graft survival and visual acuity.
Purpose of the Study:
- To conduct a meta-analysis comparing trabeculectomy, cyclophotocoagulation (CPC), and glaucoma drainage devices (GDD) for postkeratoplasty glaucoma.
- To directly assess the impact of these surgical interventions on IOP control and corneal graft survival.
Main Methods:
- Systematic literature search of Medline, EMBASE, and Cochrane Library.
- Meta-analysis of 13 clinical articles including 266 eyes.
- Primary outcomes: IOP control and corneal graft survival. Secondary outcomes: surgical failure rate and visual acuity changes.
Main Results:
- Glaucoma drainage devices (GDD) and cyclophotocoagulation (CPC) achieved greater IOP reduction compared to trabeculectomy.
- Trabeculectomy had the highest surgical failure rate (37%), while GDD had the lowest (16%).
- GDD was associated with a higher corneal graft failure rate (35%) compared to CPC (21%) and trabeculectomy (24%).
Conclusions:
- Glaucoma drainage devices (GDD) demonstrate superior IOP control and lower surgical failure rates in postkeratoplasty glaucoma.
- Despite benefits, GDD implantation carries an increased risk of corneal graft failure.
- The choice of surgical intervention requires careful consideration of the trade-off between IOP control and graft survival.
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