Abstract
Background/Objectives: To evaluate the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with glaucoma and to investigate if the usage of the prostaglandin analog latanoprost increases the risk of graft rejection. Methods: This study retrospectively reviewed 65 eyes of 61 patients with glaucoma who underwent DSAEK at King Abdulaziz University Hospital between 2009 and 2024. The risk factors for graft rejection were identified using Kaplan-Meier survival analysis and univariate and multivariate Cox regression models. Results: The graft survival rates among patients with glaucoma at 1, 3, and 5 years were 72.4%, 23.1%, and 11.5%, respectively. Latanoprost use was significantly associated with graft failure (71.4% vs. 28.6%, p = 0.024). The graft failure was mostly secondary failure (80%, p = 0.015) and was often linked to endothelial rejection episodes (62.5%). Other antiglaucoma medications were not associated with graft failure. Conclusions: Glaucoma decreases graft longevity after DSAEK. Latanoprost use may further increase the risk of graft rejection by enhancing inflammatory or immune responses. Prospective studies are warranted to confirm these findings.