Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Apr 21;12(4):e0176261.
doi: 10.1371/journal.pone.0176261. eCollection 2017.

Incidence and risk factors for post-penetrating keratoplasty glaucoma: A systematic review and meta-analysis

Suqian Wu  1 , Jianjiang Xu  1
Affiliations
Meta-Analysis

Incidence and risk factors for post-penetrating keratoplasty glaucoma: A systematic review and meta-analysis

Suqian Wu et al. PLoS One. .

Abstract

Objectives: To establish the incidence and risk factors for post penetrating keratoplasty glaucoma (PKKG).

Methods: Studies published between 1947 and 2016 regarding penetrating keratoplasty (PK) were identified using an electronic search and reviewed. For search purpose, PKKG was defined as ocular hypertension (> 21mmHg) after PK. The incidence and risk factors of PKKG were extracted for all studies. Pooled incidence, odd ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results: Thirty studies reporting on 27146 patients were included in the analysis of the incidence and risk factors for PKKG. Exact PKKG definitions used in the literature could be classified in to three subgroups: I, ocular hypertension (> 21mmHg) after PK; II, I plus > 4 weeks medical treatment required; III, II plus treatment escalation among patients with preexisting glaucoma. Overall (Definition I) pooled incidence in all studies was 21.5% (95% CI 17.8%, 25.7%). The incidence varied according to different definitions. The highest incidence value was found when only studies using Goldmann tonometer were included (22.5%), while the lowest incidence was found when a strict definition was used and steroid-induced PPKG was excluded (12.1%). The incidence was higher in patients with preexisting glaucoma, bullous keratopathy (BK), aphakia, pseudophakia, failed graft, and surgical indication of trauma. A triple procedure (combined PK with extra capsular cataract extraction and intraocular lens implantation) was not identified as being associated with the increased risk for PKKG.

Conclusions: The overall pooled incidence of PKKG was 21.5%, but it varied according to the criteria used to define the presence of PPKG. Strong risk factors for PKKG included preexisting glaucoma and aphakia, while modest predictors included pseudophakia, regrafting, and preoperative diagnosis like BK and trauma. There may not be sufficient evidence to identify a significant association between a triple procedure and PKKG.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Forest plot for the pooled incidence of PPKG Definition I.
The pooled estimate for the overall incidence (Definition I) of PPKG was 21.5% (95% CI: 17.8 to 25.7). PPKG, post-penetrating keratoplasty glaucoma.
Fig 2
Fig 2. Funnel plots of publication bias analyses for PPKG incidence (A-D) and a risk factor (E, BK).
Incidences filtered by Definition I (A), Definition II (B), retrospective studies only (C) and studies using Goldmann tonometer (D) were tested for potential publication bias. PPKG, post penetrating keratoplasty glaucoma; BK, Bullous keratopathy.
See this image and copyright information in PMC

References

    1. Haddadin RI, Chodosh J (2014) Corneal transplantation and glaucoma. Semin Ophthalmol 29: 380–396. 10.3109/08820538.2014.959201 - DOI - PubMed
    1. (1993) The Australian Corneal Graft Registry. 1990 to 1992 report. Aust N Z J Ophthalmol 21: 1–48. - PubMed
    1. Williams KA, Muehlberg SM, Lewis RF, Coster DJ (1995) How successful is corneal transplantation? A report from the Australian Corneal Graft Register. Eye (Lond) 9 (Pt 2): 219–227. - PubMed
    1. Dandona L, Naduvilath TJ, Janarthanan M, Rao GN (1998) Causes of corneal graft failure in India. Indian J Ophthalmol 46: 149–152. - PubMed
    1. Wagoner MD, Ba-Abbad R, Al-Mohaimeed M, Al-Swailem S, Zimmerman MB, King Khaled Eye Specialist Hospital Corneal Transplant Study G (2009) Postoperative complications after primary adult optical penetrating keratoplasty: prevalence and impact on graft survival. Cornea 28: 385–394. 10.1097/ICO.0b013e31818d3aef - DOI - PubMed