• Mansour Al-Mohaimeed, Sami Al-Shahwan, Abdullah Al-Torbak, and Michael D Wagoner.
• Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
• Ophthalmology. 2007 Dec 1; 114 (12): 2281-6.

PurposeTo determine the prevalence and risk factors for escalation of glaucoma therapy after penetrating keratoplasty (PK) and its impact on graft survival and visual outcome.DesignRetrospective case series.ParticipantsSeven hundred fifteen consecutive eyes of 678 patients undergoing PK.MethodsRetrospective review of every case of PK performed at King Khaled Eye Specialist Hospital between January 1, 2001 and December 31, 2002.Main Outcome MeasuresEscalation of glaucoma therapy, graft survival, and visual outcome.ResultsEscalation of glaucoma therapy occurred in 89 (12.4%) eyes of 715 PK procedures during a mean follow-up of 32.2 months. Medical escalation accounted for 73 (82.0%) cases, whereas surgical escalation occurred in 16 (18.0%) eyes. The following were significantly associated with an increased risk of escalation of glaucoma therapy: surgical indication for PK (P<0.001), increasing patient age (P<0.001), preexisting glaucoma (P<0.001), recipient trephination < 7.0 mm (P = 0.02), and pseudophakia or aphakia (P<0.001). Eyes with escalation of glaucoma therapy had significant reduction in graft survival compared with eyes in which this did not occur (52.8% vs. 82.9%, P<0.001). Escalation of glaucoma therapy was associated with a significant reduction in the percentage of eyes achieving visual acuity of 20/40 or better (9.0% vs. 42.1%, P<0.001) and a significant increase in those obtaining 20/200 or worse (70.8% vs. 26.7%, P<0.001).ConclusionsEscalation of glaucoma therapy is a serious sequela of PK that is significantly associated with an increased risk of graft failure and poor visual outcome.

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