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Repetitive penetrating keratoplasties in a monophtalmic patient with advanced operated open angle glaucoma
First Author: M. Belibou ROMANIA
Co Author(s): D. Chiseliță C. Bogdanici C. Feraru C. Sandu O. Maxim A. Alexa
Presenting the clinical features, preoperative evaluation, surgical approach, early postoperative aspect and complications in a monophthalmic patient with a history of multiple surgery glaucoma who undergoes repetitive penetrating keratoplasties in a 6- month interval. The patient is 62 years-old and has had multiple penetrating keratoplasties in the last 10 years and several glaucoma surgeries including an Ahmed valve placement. The fellow eye was lost due to absolute open angle glaucoma. The case presentation focuses on the 5-th and the 6-th corneal transplant.
Saint Spiridon University Hospital, Iasi, Romania
The patient presents in our clinic with a progressive reduction in BCVA. She is diagnosed with late onset graft rejection and undergoes the 5-th penetrating keratoplasty. The early postoperative aspect is favorable with an improvement in BCVA (from hand movement to counting fingers at 20 cm), good IOP (10 mmHg without treatment) and transparent graft. Due to the conditions imposed by the pandemic the patient was not able to attend all scheduled post-operative visits and presents after 4 months with a reduction of BCVA, no pain but mild congestion of the eye. She reports no traumatic events in the interval.
The slit lamp biomicroscopy reveals a infero-centrally perforated graft with important corneal edema of the remaining part, an absent anterior chamber, continent sutures and important vascularization in all 4 quadrants. Other details of the anterior chamber cannot be visualized due to the corneal opacification. The BCVA was hand movement with certain light perception in all quadrants. The globe was hypotonic but with an applied retina- visualized by transpalpebral echography. Judging by the clinical presentation, the lack of perilesional infiltrates and the negative cultures a diagnosis of perforated aseptic corneal ulcer was established.
A therapeutic contact lens was applied and treatment was initiated with artificial tears, autologous serum, and systemic anti-collagenase antibiotics, but without successful resolution of the ulcer. A challenging but ultimately successful penetrating keratoplasty was preformed, with a good early postoperative outcome. Repetitive chronic graft failure and graft related complications are common in glaucoma patients and regardless of the underlying mechanism prompt therapeutic intervention is a desiderate.
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