Glaucoma Escalation after Penetrating Keratoplasty

Purpose: Glaucoma following penetrating keratoplasty (PK) continues to be a serious problem that may ultimately become sight threatening. Knowledge of the risk factors for development of glaucoma following PK, such as preexisting glaucoma, pseudophakia, aphakia, and previous PK, can limit the occurrence and improve the outcome of the keratoplasty. The management of postkeratoplasty (Post-PK) glaucoma remains controversial with a wide range of treatment modalities available, including newer classes of drugs, laser therapy, filtering surgery with mitomycin C, and implantation of glaucoma drainage devices (GDDs), as well as various cycloablative treatment modalities, including cyclocryotherapy and cyclophotocoagulation (CPC) with noncontact and contact neodymium: yttrium-aluminum-garnet (Nd:YAG) laser, a semiconductor diode, and endoscopic cyclophotocoagulation (ECP). Methods: A literature search was conducted on the Medline database using the search terms glaucoma, PK, trabeculectomy, GDDs, cyclocryotherapy, Nd:YAG CPC, diode laser CPC, and ECP for the 35-year period between 1975 and 2010. Several articles that were not found by Medline search were cited in the references of other articles. Articles were included because of their subject relevance or were excluded so as to avoid redundancy. Abstracts written in English of non-English-language articles were also reviewed.