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Related Experiment Videos

Glaucoma after penetrating keratoplasty.

J W Doyle1, M F Smith

  • 1Department of Ophthalmology, University of Florida, Gainesville 32610, USA.

Seminars in Ophthalmology
|December 1, 1994
PubMed
Summary

Managing glaucoma after penetrating keratoplasty (PKP) is challenging due to pre-existing conditions and surgical complications. Treatment strategies range from medical management to surgical interventions like drainage setons or cyclophotocoagulation.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Corneal Surgery

Background:

  • Glaucoma following penetrating keratoplasty (PKP) presents significant management challenges.
  • Eyes undergoing PKP often have pre-existing conditions, multiple prior surgeries, and compromised aqueous outflow.
  • PKP surgery can further damage the anterior angle, leading to peripheral anterior synechiae and impeded aqueous outflow.

Purpose of the Study:

  • To review and outline the management strategies for glaucoma occurring after penetrating keratoplasty.
  • To discuss the complexities of controlling intraocular pressure while preserving graft clarity.

Main Methods:

  • Review of current medical and surgical treatment options for post-keratoplasty glaucoma.
  • Discussion of therapeutic algorithms based on angle status and visual potential.

Main Results:

  • Medical management, including aqueous suppressants and carbonic anhydrase inhibitors, is the first line of treatment.
  • Argon laser trabeculoplasty may be considered if the anterior angle is viable and medical therapy fails.
  • For advanced cases, drainage setons (Molteno, Baerveldt) are recommended for eyes with good visual potential.
  • Contact neodymium-doped yttrium aluminum garnet (Nd:YAG) cyclophotocoagulation (CPC) is suggested for eyes with poor visual potential or those unsuitable for surgery.

Conclusions:

  • Effective management of post-PKP glaucoma requires a stepwise approach tailored to individual patient factors.
  • Preserving graft clarity is paramount throughout the treatment process.
  • A combination of medical, laser, and surgical interventions may be necessary to control intraocular pressure and maintain visual function.

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