Dellen-like keratopathy associated with glaucoma drainage devices

Area of Science:

• Ophthalmology
• Corneal Disease
• Glaucoma Surgery

Background:

• Glaucoma drainage devices (GDDs) are used to manage intraocular pressure in glaucoma patients.
• Antimetabolite application is often used with GDDs to prevent scarring and maintain device function.
• Dry eye disease is a common comorbidity that can affect ocular surface health.

Observation:

• A 70-year-old male with primary open angle glaucoma and dry eye disease developed decreased vision and corneal irregularity years after bilateral GDD implantation.
• Examination revealed pathological corneal curvature, superior corneal thinning, and epithelial demarcation lines anterior to the GDDs.
• Corneal topography confirmed irregular curvature, distinct from limbal stem cell deficiency or epithelial defects.

Findings:

• The patient presented with dellen-like keratopathy and superior corneal thinning, a previously unreported complication of GDDs.
• The condition was associated with significant changes in manifest refraction.
• Histopathology was not performed, but clinical findings suggest a localized stromal thinning and epithelial alteration.

Implications:

• Dellen-like keratopathy with superior thinning is a rare but significant sequela of glaucoma drainage device implantation.
• This complication may be linked to altered tear film, antimetabolite use, and GDD fluidics.
• Management should prioritize aggressive ocular lubrication and monitoring for visual changes.