The combined approach in the treatment of a patient with glaucoma and endothelial-epithelial corneal dystrophy: a clinical case description

Abstract

BACKGROUND: Penetrating keratoplasty provides a possibility of restoring vision in patients with various corneal diseases, however, just like any surgical intervention, the operation is associated with certain risks and has a number of contraindications. One of the unfavorable prognostic factors in cases of penetrating keratoplasty is uncompensated glaucoma. Penetrating keratoplasty can result in the reactive postoperative hypertension, however, this is not a standard situation. In patients with a history of glaucoma, this complication occurs much more often than in patients without previously diagnosed glaucoma. The increase of intraocular pressure during the postoperative period in patients suffering from glaucoma, can lead to the progression of the disease and to the development of the transplant disease. CLINICAL CASE DESCRIPTION: This article presents a clinical case of a patient with juvenile glaucoma, which underwent several glaucoma surgeries and later he received an Ex-PRESS implanted glaucoma drainage. The drainage implant was in contact with the posterior surface of the cornea, as a result of which, initially local and further total endothelial-epithelial corneal dystrophy has developed with the formation of stromal cloudiness and progressing of pain syndrome. The drainage was removed and subsequently a decision was drawn up on arranging a penetrating corneal keratoplasty, for the critical flicker fusion rate was 30 Hz, which allowed for expecting a sufficiently high vision acuity during the postoperative period. However, despite the maximal hypotensive regimen, the intraocular pressure remained high, due to which, for the purpose of decreasing it before corneal transplantation, a transscleral diode laser cyclophotocoagulation was used. CONCLUSION: The presented clinical case demonstrates the efficiency of transscleral diode laser cyclophotocoagulation in a patient with uncompensated glaucoma in terms of the quality of preparation to penetrating keratoplasty.

Keywords

clinical case / transscleral diode laser cyclophotocoagulation / refractory glaucoma / juvenile glaucoma / intraocular pressure / penetrating keratoplasty

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