PubMed ID: 41747939
Author(s): Bal SB, Ivanov A, Kearney W, Goldberg EA, Ross C, Zebardast N, Chen TC, Friedman DS, Pineda R 2nd, Lorch AC, Miller J, Kempen JH; IRIS Registry Analytic Center Consortium. Corneal Endothelial Keratoplasty After Glaucoma Treatment: An American Academy of Ophthalmology IRIS® Registry Analysis. Ophthalmol Glaucoma. 2026 Feb 24:S2589-4196(26)00018-9. doi: 10.1016/j.ogla.2026.02.001. Epub ahead of print. PMID: 41747939.PMID 41747939
Journal: Ophthalmology Glaucoma
Purpose: To evaluate the impact of various glaucoma treatments on the incidence of corneal endothelial decompensation requiring corneal endothelial transplantation (CET) and to identify predictive factors for CET in patients with glaucoma or glaucoma suspect status.
Design: A retrospective registry-based cohort study using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).
Participants: Adults diagnosed with glaucoma or glaucoma suspect status with or without intraocular pressure (IOP)-lowering interventions. Individuals with pre-existing corneal pathology or penetrating trauma were excluded.
Methods: Demographic and clinic data were extracted for each participant-eye from January 1, 2013, to April 14, 2023, using International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification, and Current Procedural Terminology codes. The eligible cohort was followed forward in time for endothelial keratoplasty incidence. Survival analysis and multivariate Cox proportional hazards regression models were employed to estimate CET incidence and assess predictive factors for CET, defined as partial-thickness lamellar transplantation due to endothelial decompensation.
Main outcome measures: Incidence of CET used as an indicator of corneal endothelial decompensation.
Results: Among 7 827 337 eligible participants (42% men), glaucoma surgery was documented in 615 907 individuals. Overall, 8141 patients (0.13%) underwent CET (incidence rate: 0.03% per person-year). Within the subset undergoing glaucoma surgery, 27 513 (0.4%) had trabeculectomy, and 42 835 (0.5%) had tube or shunt surgery as their initial intervention. Compared to untreated eyes, the risk of subsequent CET was significantly increased after tube/shunt surgery (adjusted hazard ratio [aHR]: 6.63; 95% confidence interval [CI]: 5.93-7.41), trabeculectomy (aHR: 3.06; 95% CI: 2.62-3.59), and IOP-lowering drops (aHR: 1.15; 95% CI: 1.06-1.24). Conversely, minimally invasive glaucoma surgery (MIGS) (aHR: 0.80; 95% CI: 0.68-0.95) and laser trabeculoplasty (aHR: 0.70; 95% CI: 0.63-0.78) were associated with significantly decreased CET risk.
Conclusions: This large study highlights the substantially elevated risk of endothelial keratoplasty after traditional glaucoma surgeries such as tube/shunt implantation and trabeculectomy as well as the modestly increased risk associated with chronic topical glaucoma therapy. Conversely, MIGS and laser trabeculoplasty were associated with no increase in CET, and possibly even a protective effect on corneal endothelial health. These findings underscore the importance of selecting glaucoma treatments that optimize IOP control while preserving corneal endothelial integrity.
Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Keywords: Corneal endothelial damage; Glaucoma surgery; IRIS Registry; Keratoplasty.