Team-Based Surgical Approach To Uncontrolled Glaucoma And Corneal Failure In A Monocular Aphakic Patient

To report the management and outcomes of a complex case of refractory secondary glaucoma and corneal edema in an aphakic patient following childhood congenital cataract surgery.

The cornea clinic at our ophthalmology facility in Spain.

A 63-year-old man with a history of aphakia and secondary glaucoma in his right eye presented with severe corneal decompensation with reduced vision and uncontrolled intraocular pressure despite maximal topical and systemic therapy. The fellow eye had no visual potential. Topical antiglaucomatous therapy, although necessary, was badly tolerated, and the patient’s quality of life and ocular surface were greatly affected. The patient underwent Paul glaucoma valve implantation combined with preventive vitreoretinal surgery, assisted by an Eckhardt keratoprosthesis. This was followed by penetrating keratoplasty during the same surgical session.

Postoperative recovery was uneventful. The corneal graft remained transparent, the drainage tube was properly positioned in the vitreous cavity, and intraocular pressure was ultimately controlled. The patient continues with regular follow-up and shows satisfactory improvement in visual function.

Combined surgical approach addressing both glaucoma and corneal failure allowed adequate pressure control and preservation of ocular integrity in a challenging case of a monocular patient with secondary glaucoma and aphakia and a low quality of life due to treatment intolerance, emphasizing the value of individualized multidisciplinary management in complex anterior segment pathology.