LAUSR

PURPOSE To assess risk factors contributing to corneal decompensation following glaucoma drainage device (GDD) implantation. DESIGN Retrospective case control study. METHODS Records of 1610 eyes that underwent GDD implantation between 06/01/2009 and 04/01/2020, at the Johns Hopkins Wilmer Eye Institute were reviewed. 79 eyes (5%) developed corneal decompensation, of which 46 underwent keratoplasty. These 79 cases were matched with 220 controls. Cox proportional hazard models with robust standard error estimates to account for clustering at the matched-pair level were used to assess risk factors for corneal decompensation. Kaplan-Meier Survival Analysis analyzed time to corneal decompensation. RESULTS Mean (SD) age of cases and controls was 68 (12.3) and 60.5 (15.9) years, respectively. The mean time from GDD implantation to corneal decompensation was 32 months, and the cumulative probability of developing decompensation at 3, 6, and 9 years was 4.7%, 9.2%, and 14.8%, respectively. Final visual outcomes in cases were worse, with a final mean±SD visual acuity (LogMAR) of 1.96±1.25 relative to a mean±SD visual acuity of 1.11±1.36 in controls (p<0.001). In the multivariable model, significant risk factors for corneal decompensation were increased age (adjusted hazard ratio (AHR), 1.39; 95%CI:1.18-1.63; p=<0.001), history of Fuchs dystrophy or ICE Syndrome (AHR, 9.18; 95%CI:5.35-15.74; p=<0.001), and postoperative complications such as hypotony (AHR, 3.25; 95%CI:1.85-5.72; p=<0.001) and tube cornea-touch (AHR, 6.37; 95%CI:3.77-10.75; p=<0.001). CONCLUSIONS The risk of postoperative corneal decompensation is persistent over time. Patients receiving GDDs, particularly those with advanced age, preexisting corneal pathology, and postoperative complications, should be counseled regarding their increased risk for corneal decompensation.