Secondary glaucoma treatment and graft failure in penetrating keratoplasty for advanced acanthamoeba keratitis: 5 years follow-up

Background: there is limited evidence regarding treatment options for secondary glaucoma after penetrating keratoplasty (PK) in the management of Acanthamoeba keratitis (AK).<br/><br/>Aims: to investigate glaucoma treatment options in patients who underwent PK for advanced AK.<br/><br/>Methods: a retrospective case-series review of patients who underwent PK for AK and were diagnosed with intraocular hypertension or glaucoma. Inclusion criteria included a diagnosis of AK confirmed by positive confocal microscopy or culture, PK for advanced AK, a diagnosis of glaucoma or ocular hypertension post-PK, and a minimum follow-up period of five years or achieving endpoints such as no perception of light vision, phthisis bulbi, or enucleation. Exclusion criteria consisted of a prior glaucoma or ocular hypertension, insufficient follow-up, or failure to meet the required endpoint.<br/><br/>Results: 271 PKs were investigated, of which six eyes (six patients) met inclusion criteria. Three patients underwent therapeutic surgery, while three had optical grafts for corneal scarring. Additionally, three patients received treatment with topical medication. One patient had cataract extraction with anterior synechiolysis, another required trabeculectomy, and one patient underwent Ahmed valve implantation. Early graft failure, the necessity for glaucoma surgery, poor visual outcomes, or the need for evisceration have been linked to more severe initial infections, co-existing infections, or reactivation of keratouveitis.<br/><br/>Conclusion: the management of glaucoma patients who underwent PK for AK can be complex, and outcomes depend on many factors. Currently, no comparative data is available on managing these patients. This comparative case series provides the first evidence for various treatments and compares them with the available literature.