Outcomes of Trabeculectomy and Glaucoma Drainage Devices for Elevated Intraocular Pressure After Penetrating Keratoplasty (original) (raw)
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Glaucoma Drainage Device (GDD) Implantation in Post Trabeculectomy Patients
International Journal Of Scientific Advances
Objective: This study aims to report a case of Glaucoma Drainage Device (GDD) implant surgery in a patient who experienced an increase in Intraocular Pressure (IOP) after long term trabeculectomy. Case Presentation: A 58-year-old male patient came with complaint of blurred vision since two years ago. Patient did not complain of sore and red eyes. He was given 2 x 250 mg of Acetazolamide, 2 x 1 tablet of Aspar K, 2 x 1 right and left eye (RLE) of Latanoprost, and 2 x 1 RLE of Betaxolol HCl. The patient had glaucoma since 20 years ago and had undergone surgery in 2002 on the right eye and left eye surgery in 2004. His right eye intraocular pressure was 38 mmHg with conjungtival bleb (+) flat (+) minimal vascularity (+) horizontal extent 1-2 clock hours. Patient then underwent a GDD implant surgery on the right eye, IOP 8 mmHg post GDD. Three months after surgery, the visual acuity decrease into 6/120 ph 6/21, elevated IOP into 32 with prominent lens opacity, so the phacoemulsification...
Five-year Outcomes of Eyes With Glaucoma Drainage Device and Penetrating Keratoplasty
Journal of Glaucoma, 2012
Purpose-To investigate intraocular pressure (IOP) control and corneal graft survival rates in eyes with glaucoma drainage device (GDD) implantation and penetrating keratoplasty (PK) and 5 years of follow-up data. Design-Retrospective review. Methods-We performed a review of records of all patients who underwent both GDD placement and PK at our institution between January 1, 1988 and December 31, 2003. Twentyeight eyes of 27 patients were studied. Glaucoma outcome was assessed by postoperative IOP, number of glaucoma medications, and need for further glaucoma surgery. Corneal grafts were assessed for clarity. Results-All eyes had GDD placement in the anterior chamber. The mean pre-GDD IOP was 28.8 ± 10.3 mm Hg on a mean of 2.6 ± 0.8 glaucoma medications. At 5-year follow-up, the mean IOP was 13.0 ± 5.9 mm Hg on a mean of 0.9 ± 1.0 glaucoma medications. GDD implantation successfully controlled glaucoma in 96%, 86%, 79%, 75%, and 71% of eyes at 1, 2, 3, 4, and 5 years, respectively. Grafts remained clear in 96%, 82%, 75%, 57%, and 54% of eyes at 1, 2, 3, 4, and 5 years, respectively. Failure of glaucoma outcome or graft survival was associated with prior intraocular surgeries. Conclusions-Our data suggests that GDD placement can provide glaucoma control in a high percentage (71%) of eyes with PK even at 5 years. Furthermore, the success of PK in eyes with GDD remains reasonable (54%) at 5 years. IOP control and graft survival rates are comparable with earlier published studies with shorter follow-up or tube placement in the vitreous cavity.
Glaucoma after penetrating keratoplasty: Risk factors and its management
IP innovative publication pvt. ltd, 2019
Abstract Glaucoma is the second leading cause of graft failure after penetrating keratoplasty. Prompt diagnosis and aggressive management is mandatory to salvage the graft. Indications of penetrating keratoplasty, lens status, additional procedures with penetrating keratoplasty, preexisting glaucoma and re-graft are the main risk factors for glaucoma after penetrating keratoplasty. Various newer modalities like recent tonopens, ultrasound biomicroscopy, and anterior segment optic coherence tomography are helpful tools for its diagnosis. Various newer drugs, surgical modifications such as trabeculectomy with antimetabolites like mitomycin-C and 5 fluorouracil, glaucoma drainage devices, cyclodestructive procedures have added the chances of success of its management, but still graft failure secondary to glaucoma is very common. Keywords: Trabeculectomy, Glaucoma drainage device, Graft failure.
Selective laser trabeculoplasty for glaucoma after penetrating keratoplasty
Optometry & Vision …, 2009
Background. To investigate the efficacy of selective laser trabeculoplasty (SLT) for lowering intraocular pressure (IOP) in patients with open angle glaucoma (OAG) secondary to emulsified silicone oil (SO). Methodology/Principal Findings. Prospective, interventional, consecutive case series of 11 eyes with sustained elevation of IOP after SO removal. The mean IOP at baseline, week 1, month 1, month 3, and month 6 was evaluated. The mean baseline IOP was significantly decreased from 25 ± 2.7 mmHg to 18.4 ± 5.5 mmHg at week 1 (= 0.01), 17.9 ± 3.1 mmHg at month 1 (= 0.008), 15.8 ± 3.9 mmHg at month 3 (= 0.003), and 16.2 ± 4.7 mmHg at month 6 (= 0.004). IOP < 21 mmHg was achieved in 91% of the eyes without a significant complication at month 6. Conclusion/Significance. SLT may be successful for lowering IOP in patients with OAG secondary to emulsified SO which was not controlled with maximum antiglaucomatous medical treatment.
IOSR Journals , 2019
Purpose: TO STUDY AND COMPARE THE LONG TERM EFFICACY (INTRA OCULAR PRESSURE REDUCTION) WITH PENETRATING (TRABECULECTOMY) VS NON PENETRATING (DEEP SCLERECTOMY) GLAUCOMA SURGERY Methods: In this study, 35 eyes underwent trabeculectomy (group A)and 35 eyes underwent deep sclerectomy (group B). Applanation tonometry was performed at 1st day, 1 week, 1 month, 3 month, 6 month, 1 year and 7 years postoperatively. The variable included was the intra ocular pressure using goldmann applanation tonometer. Results: Overall, the mean preoperative IOP in group A patients was 28.2 +-2.70 mmHG and in group B it was 26.2+-5.70 mmHG. The mean post operative IOP on day 1 was 9.1 +-2.12mmHG and 8.2+-1.76 mmHG in group A and group B respectively. A reduction of 68.2% in group A and a reduction of 69.6% In group B was observed. Reduction in the mean IOP at 1 year and 7 year was 42.4 % and 38.6 % in group A and 30.2 % and 24.2 % in group B respectively. Out of 35 patients in group A, 3 patients were prescribed one group of anti glaucoma medication post operatively due to marginally high intra ocular pressure Out of 35 patients in group B, 7 patients had to undergo trabeculectomy with the application of MMC due to persistently high intra ocular pressure The mean reduction reduced over time in both the groups compared, which was observed more in the group B patients. Conclusion : Our study observed that although both the penetrating and non-penetrating surgeries significantly lowered the IOP in patients with primary open angle glaucoma, the patients who underwent non-penetrating surgery (deep sclerectomy) provided comparable reduction in the IOP with fewer complications.
Postoperative management of trabeculectomy and glaucoma drainage implant surgery
Current Opinion in Ophthalmology, 2016
Purpose of review This article describes important aspects of postoperative management after trabeculectomy and glaucoma drainage implant surgery. Recent findings Postoperative management of glaucoma drainage implant surgery includes stabilization of intraocular pressure, possible ligature release, and management of complications such as corneal edema, and tube/ plate exposure. Postoperative management of trabeculectomy includes evaluation of bleb encapsulation, management of hypotony, and assessment of need for adjuvant therapy. Recent advances in surgical techniques, device/tissue availability, and imaging continue to shape the postoperative course. Summary Careful preoperative planning and postoperative care may decrease the likelihood of complications in tube surgery or trabeculectomy.
Glaucoma after Penetrating Keratoplasty: Incidence, Risk Factors, and Management
Journal of Ophthalmology, 2011
Purpose. To report the incidence and risk factors for postkeratoplasty glaucoma (PKG), as well as its management.Subjects and Methods. 122 eyes, (43% with pseudophakic and aphakic bullous keratopathy (PABK)) which underwent penetrating keratoplasty (PK), were analyzed.Results. The rate of PKG development was 34% within 39 months of follow-up. PABK, corneal perforations, keratitis, and previous high intraocular pressure (PHIOP) were high risk factors for PKG. Glaucoma was controlled medically in 62% of PKG cases. Surgery (Ex-PRESS shunt in 63%) and diode laser cyclophotocoagulation were applied in others (38%). The rate of postoperative complications and graft survival was similar in eyes with and without PKG.Conclusion. PHIOP, preoperative diagnoses other than keratoconus, and corneal dystrophies were highly associated with PKG. Ex-PRESS shunts were effective in refractory PKG. If glaucoma is controlled, it is possible to obtain similar rates of graft survival and postoperative comp...