Materials and Methods: Thirty-nine patients who had penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) surgeries and developed graft rejection and post-keratoplasty glaucoma were included in the study. We evaluated the indications for keratoplasty, surgical techniques, trephine diameters, number of transplants, intraocular pressure (IOP), best-corrected visual acuity (BCVA), follow-up duration, and history of glaucoma surgery. Patients with failed grafts at final follow-up were considered to have graft rejection.

Results: The most common indication for keratoplasty was bullous keratopathy, and half of the patients had an intraocular lens. PKP was performed in 36 (92.3%) patients, and DALK was performed in 3 (7.7%) patients. Rekeratoplasty was applied to 24 (61.5%) patients. The mean follow-up period was 86.17 ± 28.33 months. Seven patients underwent trabeculectomy, four patients had Ahmed glaucoma valve (AGV) implantation, and two patients had both surgeries. We found no statistically significant effect of glaucoma surgery on failed graft (p = 0.495). Additionally, factors such as age, gender, intraocular lens status, and trephine size did not influence failed graft. We determined a failed graft rate of 66% despite the presence of glaucoma in rekeratoplasty patients.

Conclusion: In patients who developed failed graft and glaucoma after keratoplasty, we believe that performing glaucoma surgery when intraocular pressure cannot be controlled with medical treatment, and providing patients with the opportunity for rekeratoplasty, is crucial for enhancing graft survival. Keywords : deep anterior lamellar keratoplasty, glaucoma, failed graft, penetrating keratoplasty, trabeculectomy 72 Copyright © 2026 The author(s). This is an open-access article under the terms of the Creative Commons Attribution License (CC BY) which permits