A systematic review and network meta-analysis of surgical interventions for glaucoma following penetrating keratoplasty.

This study aims to compare the effectiveness and safety of surgical interventions for secondary glaucoma following penetrating keratoplasty (PKP) through a network meta-analysis. PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Scopus, and Google Scholar databases were searched for articles published from inception to July 16, 2024. We included studies that compared the effects of trabeculectomy, glaucoma drainage devices (GDDs), or cyclophotocoagulation (CPC) on graft failure, intraocular pressure (IOP), or the number of glaucoma medications required for patients with post-PKP glaucoma. Based on data synthesized from 13 cohort studies, we observed that valved GDDs are not associated with a higher risk of graft failure (risk ratio [RR], 1.49; 95% confidence interval [CI], 0.89 to 2.48) compared with trabeculectomy with antifibrotic agents. Valved GDDs demonstrated greater benefits in achieving successful IOP control (RR, 1.33; 95% CI, 1.08 to 1.64), reducing IOP from baseline (mean difference [MD], - 3.08; 95% CI, - 5.36 to - 0.81), and reducing the number of glaucoma medication usage from baseline (MD, - 0.53; 95% CI, - 0.94 to - 0.12) compared with trabeculectomy with antifibrotic agents. In conclusion, valved GDDs may be the preferred surgical option for managing post-PKP glaucoma.