Corneal Transplantation Increases Glaucoma Development and Progression Risk

Glaucoma management must be considered prior to performing corneal transplantation.

Corneal transplantation can lead to an increased risk of glaucoma development and progression within 1 year following the procedure, according to a retrospective study published in Eye.  

Researchers included 431 patients (mean age, 65.9 years; mean follow-up, 22.9 months; 431 eyes) who underwent penetrating keratoplasty (PK; n=113), deep anterior lamellar keratoplasty (DALK; n=17), Descemet stripping endothelial keratoplasty (DSEK; n=71), Descemet membrane endothelial keratoplasty (DMEK; n=168), Boston keratoprosthesis type I (KPro; n=35) implantation and endothelial keratoplasty (EK) under previous PK (n=27) in the retrospective analysis. All patients underwent corneal transplantation at a single center between April 2016 and December 2019. A total of 246 patients (57.1%) did not have preoperative glaucoma.

The 1-year cumulative incidence of glaucoma development and progression was 28.0% and 17.8% for patients without and with preoperative glaucoma, respectively. Based on the Cox regression analysis, PK surgery, KPro implantation and average postoperative intraocular pressure (IOP) were associated with glaucoma development in patients with no preoperative glaucoma, and KPro implantation and an IOP spike of 30 mm Hg or higher during follow up were associated with glaucoma progression in patients with preoperative glaucoma, the report shows. 

Postoperative IOP spikes should be minimized and may indicate the need for co-management with a glaucoma specialist.

At the final follow up, 36 patients (8.3%) required glaucoma surgery. Male sex, non-White race, DSEK surgery, KPro implantation and an IOP spike of  30 mm Hg or higher were associated with glaucoma surgery following corneal transplantation. 

“Postoperative IOP spikes should be minimized and may indicate the need for co-management with a glaucoma specialist,” according to the researchers. “Our study provides important clinical parameters for managing glaucoma in high-risk corneal transplant patients, who may require multidisciplinary care to reduce irreversible vision loss.”

Study limitations include its retrospective nature, single center design and limited sample size of certain corneal transplant types. 

Disclosure: This research was supported by Boston Keratoprosthesis Fund. Several study authors declared affiliations with biotech, pharmaceutical, and/or clinical research organizations. Please see the original reference for a full list of authors’ disclosures.


Saini C, Davies EC, Ung L, et al. Incidence and risk factors for glaucoma development and progression after corneal transplantation. Eye. Published online November 3, 2022. doi:10.1038/s41433-022-02299-6