Penetrating Keratoplasty and Advanced Glaucoma - Results after Implantation of Drainage Devices
Nölle B., Amm M.
Augenklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
Purpose: Advanced glaucomas after penetrating keratoplasty are frequently observed in patients with aniridia, aphakia, injuries or dystrophies of anterior chamber angle.The success after implantation of glaucoma drainage devices is proven in keratoplasty-patient with advanced uncontrolled glaucoma.
Method: A Baerveldt glaucoma system was implantet in seven patients, in one case a Molteno-system was used. The patients (n=8) were between 1 and 66 years old (6M, 2F). Each had a history of 1-3 penetrating keratoplasties and 1-4 glaucoma surgeries. Despite 2-5 anti-glaucoma medications given, the glaucomas were not controlled. Aniridia was present 3x, aphakia 5x and angle lesions in all cases.
Results: Ocular tension was normal after surgery in 7/8 patients without additional glaucoma medication (follow-up: 1-19 months). Within the first 2 weeks hyperfiltration,ocular hypotonia, and fibrinous exsudation was striking. On the longterm no complications were seen. In five patients visual acuity increased.
Conclusions: Surgical intervention in progressive glaucomas after penetrating keratoplasty should include glaucoma drainage devices. Decision for surgical intervention should be early, as glaucoma may be difficult to diagnose after keratoplasty.
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