This study aimed to evaluate the rate of corneal graft failure in eyes with glaucoma drainage device (GDD) placed in the anterior chamber (AC) versus the ciliary sulcus (CS).

This was a retrospective chart review of eyes with coexisting corneal transplant and GDD between January 2014 and December 2021 at an academic medical center. The primary outcome was incidence of corneal transplant failure. Groups were compared with logistic regression modeling utilizing generalized estimating equations with an unstructured correlation to account for patients with two eyes included. Adjusted odds ratios (OR) and 95% confidence limits were determined for the primary outcome. Kaplan-Meier curves were used to demonstrate the time to failure.

Among 58 eyes, the graft failure rate for GDDs placed in the AC versus CS was 42.5% and 10.5%, respectively (p = 0.05). Male patients had higher odds of failure, OR 3.5 (95% CI 1.1, 10.4, p = 0.03). Maximum intraocular pressure, topical carbonic anhydrase inhibitor use, and type of corneal graft were not significantly associated with failure. The Kaplan-Meier survival curve demonstrated higher corneal transplant failure probabilities for eyes with GDD in the AC versus CS (p = 0.06). GDD location, after adjusting for sex, was not significantly associated with failure, OR 3.0 (95% CI 0.8, 11.6, p = 0.10).

Corneal transplant failure rates were four times higher in eyes with GDDs in the AC compared to the CS, but the difference was not statistically significant. Further studies with larger sample sizes and follow-up are needed to fully explore differences in failure rates by GDD placement.