Surgical management for postkeratoplasty glaucoma: a meta-analysis.

Purpose: To perform a meta-analysis on postkeratoplasty glaucoma and directly compare the affect of trabeculectomy, cyclophotocoagulation (CPC), and glaucoma drainage device (GDD) on intraocular pressure (IOP) control and corneal graft survival.

Methods: We searched Medline (Ovid, PubMed), EMBASE, and The Cochrane Library databases for clinical articles that maintained our inclusion criteria. The primary outcome measures were IOP control and overall corneal graft survival. The secondary outcomes were failure rate of the primary glaucoma procedure and change in visual acuity. We used 1-way analysis of variance weighed by the number of participants in each study to compare the outcomes.

Results: Information from a total of 266 eyes was collected from 13 articles. Trabeculectomy reduced IOP by 13.6 mm Hg compared with 20.4 mm Hg with CPC and 20.2 mm Hg with GDD (P<0.001). The failure rate of glaucoma surgery was highest after trabeculectomy 37% (95% CI, 31.4%-41.9%) compared with 20.7% (95% CI, 17.6%-23.7%) after CPC and 16% (95% CI, 13.8%-18.9%) after GDD and this was statistically significant (P<0.001). GDD was associated with higher rate of corneal graft failure (35%) than either CPC or trabeculectomy (21% and 24%, P=0.001 and P<0.001, respectively). The percentage of patients who experienced worsening of vision was the highest after CPC (26%) and the least with GDD (20%).

Conclusions: Our meta-analysis shows that in patients with postkeratoplasty glaucoma, GDD is associated with greater IOP control, the lowest glaucoma surgery failure rate, and less vision loss compared with other forms of glaucoma surgery. However, GDD surgery is also associated with higher rate of graft failure.