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Keratoplasty in iridocorneal endothelial syndromes: survival of the graft in glaucoma

Poster Details

First Author: E.Infantes Molina SPAIN

Co Author(s):    L. Riveira Villalobos   E. Lopez Mondejar   J. Zarco Tejada   J. Celis Sanchez   E. Avendano Cantos   L. Alfaya Munoz     

Abstract Details

Purpose:

To report 2 clinical cases of patients with Iridocorneal Endothelial Syndrome (ICE) underwent corneal transplantation, highlighting the difficulty of control of the intraocular pressure (IOP) and its influence on the survival of graft.

Setting:

La Mancha Centro General Hospital, Alcázar de San Juan, Ciudad Real. Spain

Methods:

2 clinical cases are described Case 1 Woman was 59 years old with bullous keratopathy in OS, ICE, trabeculectomy and Ahmed valve. We performed extracapsular cataract extraction, IOL implantation, iridoplasty, implantation of iris sector and penetrating keratoplasty. BCAV reached was 0.6 but the IOP increased to 33 mmHg then endocyclophotocoagulation was performed. Case 2 Woman was 28yo with bullous keratopathy in OR, with ICE syndrome, trabeculectomy and Ahmed valve. DMEK is performed. BCAV achieved 0.7 but the IOP reached 30mmHg, endothelial count decreased rapidly. We decided to make a RE-DMEK.

Results:

Case 1: The corneal suffered infection bacterial, now it has a big central leukoma. The BCAV is only 0.05 with IOP 11. Case 2: 6 months after retransplantation the IOP is 13 mmHg with simple topical treatment, reaching a BCAV 0.4.

Conclusions:

ICE is a progressive proliferative corneal endotheliopathy. 50% of cases develop glaucoma of difficult control due to either peripheral anterior synechias or by coating the trabecular meshwork of the cell membrane. The preoperative glaucoma and the use of topical glaucoma medications are risk factors of rapid corneal graft failure. Our patient had these complications. They underwent several surgeries in their eyes with persistently elevated IOP so there are risk factors that predict short survival and irreversible failure of the corneal grafts for endothelial decompensation without a immunologic reaction.

Financial Disclosure:

NONE

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