Goniosynechialysis Combined with iStent Implantation for Refractory Angle Closure Following Tectonic Penetrating...

To report a case in which a targeted early minimally invasive glaucoma surgery (MIGS) approach successfully prevented irreversible sight loss from acute secondary angle closure following tectonic penetrating keratoplasty (PKP) in an eye with a prior porcine-derived corneal stromal implant (Xenia®) as treatment for advanced keratoconus.

The authors describe successful surgical treatment of a patient who developed acute intraocular pressure (IOP) elevation following tectonic PKP for perforated bacterial microbial keratitis. We demonstrate that combined goniosynechialysis (GSL) and iStent Inject® trabecular micro-bypass implantation are effective in reversing postoperative synechial angle closure, restoring angle integrity, and preventing progressive glaucomatous optic neuropathy and, thus, irreversible sight loss in an eye with a functioning PKP.

The authors highlight the importance of early recognition and referral to a glaucoma specialist for prompt mechanism-targeted MIGS to manage postkeratoplasty secondary angle closure.

Early targeted MIGS intervention may prevent the need for complex glaucoma filtration surgery in eyes with secondary synechial angle closure following corneal transplant surgery.