Penetrating Keratoplasty Caused Neurotrophic Keratopathy And Secondary Glaucoma

Neurotrophic keratopathy(NK) is corneal disease caused by impairment of trigeminal innervation with decreased corneal sensitivity, epithelial breakdown, ulceration, melting, perforation. Causes: ocular and systemic conditions with fifth cranial nerve damage at any level causing hypoesthesia with sensory/trophic function impairment. Ethiology: herpes keratitis (zoster/simplex), topical anesthetic, burns, contact lens abuse, ocular surgery, laser procedure, dystrophies. Non-ocular causes include neurosurgical procedures, trauma, stroke, aneurisms, multiple sclerosis, intracranial masses, diabetes mellitus, leprosy. Secondary glaucoma after corneal surgery is common in penetrating keratoplasty(25%), lamellar keratoplasty(5%).

Examination and diagnose of this case was perform at Eye Clinic, University Clinical Center Nis based on clinical presentation

55(F)referred to ophthalmology clinic due to redness,epiphora in left eye.Ocular history:penetrating keratoplasty procedure(PKP),1987.Few years before surgery anterior keratoconus was diagnosed,stage I-right eye(OD), stage II-III in left eye(OS)(Amsler-Krumeich).Snellen chart BCVA:OD=0.9;OS=0.5/60. Acute worsening in OS.Acute corneal hydrops occurred.She underwent penetranting keratoplasty.Wound dehiscenced few days after and was re-sutured. She gained VA(OS=0.1-0.2).Tree years later,rejection of corneal graft.Treated with immunosuppressive corticosteroid drops. IOP(13mmHg).Controlled yearly.corneal graft not transparent,showed scarring,oval epithelial/stromal defect,infiltrated borders.TBUT(OD=9s;OS=4s);(Schirmer test OD= 11mm OS=3mm)

In past few years she suffered secondary postoperative glaucoma (30-40mmHg) treated with: timolol, dorzolamide, brimonidine, acetazolamide per oral and Manitol 20% intravenous. Preservative free artefitial tears- Sodium Hialuronate hourly, Ofloxacin ointment qid, retinol palmitate (Vitamin A) ointment 250i.j./g bid. Rapid clinical improvement achieved in 14days with SPK (superfitial punctate keratopathy) and discrete staining, less corneal edema, few Descemet folds, TBUT improved 5-10s.

Prognostic indicators in neurotrophic keropathy include the degree of sensory loss, the duration of the condition, and the presence of Ocular Surface Disease (OSD). Medical management is essential: lubricating, anti-inflammatory agents, antibiotics, contact lenses, punctal plugs, lid closure. Surgical interventions include tarsorrhaphy, conjunctival flaps and amniotic membrane provide greater success. Corneal surgery in a dry ocular surface with reduced sensation is at high risk of failure. This case presents complications after penetrating keratoplasty: Neurotrophic Keratopathy and Secondary glaucoma after corneal surgery as common complication that was sucesfully treated