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Graft Survival Versus Glaucoma Treatment After Penetrating or Descemet Stripping Automated Endothelial Keratoplasty

Ward, Matthew S. MD; Goins, Kenneth M. MD; Greiner, Mark A. MD; Kitzmann, Anna S. MD; Sutphin, John E. MD; Alward, Wallace L.M. MD; Greenlee, Emily C. MD; Kwon, Young H. MD, PhD; Zimmerman, M. Bridget PhD; Wagoner, Michael D. MD, PhD

doi: 10.1097/ICO.0000000000000170
Clinical Science

Purpose: The aim of this study was to assess and compare the association of glaucoma therapy with graft survival after performing penetrating keratoplasty (PKP) and Descemet stripping automated endothelial keratoplasty (DSAEK).

Methods: A retrospective chart review was performed of cases: primary PKP from January 1, 2003, to December 31, 2005, or primary DSAEK from January 1, 2006, to December 31, 2008. Eyes with a surgical indication of pseudophakic corneal edema were included in the statistical analysis. Eyes were stratified by glaucoma treatment into those with (1) no glaucoma treatment, (2) medical therapy only, or (3) surgical intervention. The main outcome measure was graft survival.

Results: Fifty-seven PKP-operated and 156 DSAEK-operated eyes met the inclusion criteria. After PKP and DSAEK, respectively, the 5-year Kaplan–Meier graft survival was 94.7% and 93.8% in eyes with no glaucoma treatment (P > 0.99), 93.8% and 96.3% in eyes with medical therapy only (P > 0.99), and 56.8% and 50% in eyes with surgical intervention (P > 0.99). After both procedures were performed, graft survival was significantly worse in eyes with surgical intervention compared with that in eyes with no glaucoma treatment (P < 0.0001) or in eyes with medical therapy alone (P < 0.0001).

Conclusions: PKP and DSAEK have comparable graft survival in eyes without glaucoma management and in those with comparable glaucoma management.

*Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA;

Department of Ophthalmology, Kansas University Medical Center, Kansas City, KS; and

Department of Biostatistics, School of Public Health, University of Iowa, Iowa City, IA.

Reprints: Michael D. Wagoner, MD, PhD, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Pomerantz Family Pavilion, 200 Hawkins Drive, Iowa City, IA 52242-1091 (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received March 17, 2014

Accepted April 28, 2014

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