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Case Reports
. 2023 Mar 18:16:179-185.
doi: 10.2147/IMCRJ.S402944. eCollection 2023.

Challenges in Managing Secondary Glaucoma Post-Repeat Penetrating Keratoplasty in a Developing Country

Emma Rusmayani #  1 , Johan A Hutauruk #  1 , Viona Viona #  1
Affiliations
Case Reports

Challenges in Managing Secondary Glaucoma Post-Repeat Penetrating Keratoplasty in a Developing Country

Emma Rusmayani et al. Int Med Case Rep J. .

Abstract

Purpose: To illustrate the complexity in managing secondary glaucoma post-repeat penetrating keratoplasty in a developing country.

Case description: A patient with a history of five repeat penetrating keratoplasties (PKPs) showed good intraocular pressure (IOP) control with trabeculectomy; however, blebitis occurred as an undesirable complication. Trabeculectomy was done rather than tube implantation due to socioeconomic factors, although it's not an ideal treatment. After the infection subsided, we performed a bleb revision with a scleral patch graft. Intraocular pressure was high in the follow-up period after the scleral patch, therefore we decided to do tube implantation. Following glaucoma tube implant surgery, the patient had good IOP control and a clear graft after six months of follow-up.

Conclusion: Secondary glaucoma post repeat PKPs is challenging in both diagnosis and management. Immediate action is imperative to control IOP, prevent glaucoma progression, and minimize corneal graft damage. In addition to medical reasons, socioeconomic factors should be considered.

Keywords: blebitis; repeat penetrating keratoplasty; secondary glaucoma; tube implant.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Failed graft after repeat penetrating keratoplasties. The patient complained of a significant decrease in vision, redness, grittiness, and pain.
Figure 2
Figure 2
Patient one-week post-trabeculectomy with clear graft.
Figure 3
Figure 3
Thin, avascular bleb and no leak at one-month follow-up post-trabeculectomy with mitomycin C.
Figure 4
Figure 4
Scleral thinning 22-months post-trabeculectomy with mitomycin C.
Figure 5
Figure 5
Bleb leak with positive Seidel test viewed after fluorescein staining.
Figure 6
Figure 6
One-week post bleb revision with scleral patch.
Figure 7
Figure 7
Clear graft six months after Ahmed tube implant positioned in the posterior chamber.
Figure 8
Figure 8
Tube positioned behind the iris with extensive peripheral anterior synechia.
See this image and copyright information in PMC

References

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