Problems associated with penetrating keratoplasty for corneal edema in congenital glaucoma

Corneal edema from congenital glaucoma is a rare indication for penetrating keratoplasty. We report the complications and problems associated with eight consecutive penetrating keratoplasties performed in adult eyes with a history of congenital glaucoma. Only 25% of the eyes achieved 20/40 or better vision after surgery. These generally poor results can be attributed to previous glaucomatous optic nerve damage, to complications related to previous surgery, and possibly to amblyopia. The most common surgical complication was postoperative elevation of intraocular pressure, which occurred in all the cases (8/8 eyes), and required permanent augmentation of glaucoma medications in seven eyes (88%), and glaucoma surgery in four eyes (50%). Two eyes (25%) developed corneal graft failure, one from immune rejection and the other from severe postoperative glaucoma necessitating cyclocryotherapy. In view of these complications and the multiple impediments to good postoperative vision, we advise that penetrating keratoplasty be reserved for patients with severe visual disability whose preoperative glaucoma is well controlled.