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To determine the prevalence and risk factors for escalation of glaucoma therapy after deep lamellar endothelial keratoplasty (DLEK).Retrospective review of every case of DLEK performed at a tertiary care facility between December 1, 2003 and January 31, 2006.Eighty eyes met the inclusion criteria. Escalation of glaucoma therapy occurred in 13 eyes (16.3%) during a mean follow-up period of 27.1 months. Ten eyes required additional topical medical therapy, and 3 eyes required surgical intervention. Glaucoma therapy escalation was significantly associated with preexisting glaucoma (42.9% vs. 10.6%; P = 0.008).Escalation of glaucoma therapy is not uncommon after DLEK, especially in eyes with preexisting glaucoma.