Clinical characteristics and managements of severe corneal ulcers in patients with end-stage glaucoma

To review the clinical characteristics and managements of severe corneal ulcers in patients with end-stage glaucoma.

Retrospectively reviewed the medical records of patients diagnosed with severe corneal ulcers who had a history of end-stage glaucoma, including demographic profiles, medical histories, clinical features, and treatments.

Thirty patients (30 eyes) were included. The median age at presentation was 73.00 years (interquartile range [IQR]: 64.25-77.25 years). The majority of patients were previously diagnosed with primary angle-closure glaucoma (11/30, 36.67%). Nineteen patients (63.33%) were still using antiglaucoma medications within 6 months before the onset of corneal ulcer. Visual acuity was already severely impaired in these patients before the onset of corneal ulcer. At last visit before the onset, 20 eyes (66.67%) had intraocular pressure (IOP) greater than 21 mmHg. Corneal perforation occurred in 13 eyes (43.33%). Eleven eyes (36.67%) underwent debridement of corneal ulcer and conjunctival flap covering surgery, while 13 eyes (43.33%) eventually underwent evisceration. Patients without corneal perforation had received a greater variety of surgical or laser treatments in the past compared to those with corneal perforation (P = 0.047). A significantly larger proportion of patients with corneal perforation underwent evisceration (9/13 vs 4/17, P = 0.012).

Severe corneal ulcers in patients with end-stage glaucoma were characterized by advanced age, long-term use of topical antiglaucoma medications and poor IOP control. Nearly half of the patients lost their eyes. Active treatment of underlying diseases and careful attention to ocular surface condition are crucial in preventing corneal perforation and improving prognosis.