Posters

Keratoconus and cortisonic glaucoma: a case report

Poster Details

First Author: K.Zrikem MOROCCO

Co Author(s): M. Issiaka   Y. Hidane   A. Mchachi   L. Benhmiddoune   R. Rachid   M. Elbelhadji     

Abstract Details

Purpose:

Keratoconus is a non-inflammatory disease characterized by thinning and bulging of the cornea. Ocular rubbing is one of the factors that strongly increase the severity of keratoconus, especially in cases of allergic conjunctivitis, often requiring a combination of antihistaminic and corticosteroid based medications which can induce the occurrence of cortisonic glaucoma. We report a case of cortisonic glaucoma in keratoconus non responding to medical treatment requiring surgical management.

Setting:

Adult ophthalmology department - 20 August Hospital 1953 - Ibn Rochd University Hospital

Methods:

Patient of 22 years, with stage3 keratoconus bilateral followed for 8 years and corrected by rigid lens gas permeable (LCGP), with notion of treatment by local corticosteroids for allergic conjunctivitis evolving for 12 years, inducing a cortisone glaucoma refractory to medical treatment for 2 years. The average intraocular pressure remains above 28 mmHg under quadritherapy with a visual acuity loss despite of LCGP wearing. The analysis of the different visual fields shows an alteration with a decreasing monitoring curve. Papillary OCT data show bilateral degradation of the ganglionic layers. Surgical treatment has been preferred using microinvasive glaucoma surgery (MIGS) technique.

Results:

Keratoconus is largely associated with a field of allergic conjunctivitis, often requiring the introduction of long-term corticosteroid therapy or steroid automedication. Cortisonic glaucoma is an entity of glaucoma  that responds poorly to medical treatment. In patients with a keratoconus-glaucoma association, lens wear impinges on the filtration bubble generated by trabeculectomy and leads to a decrease in filtration and failure of surgery. New techniques have been introduced including the MIGS, including various techniques, supported by different medical devices, which involve placing a micro-drain or stent in the flow pathways to facilitate evacuation of the aqueous humor surgery (surgery without bubble filtration).

Conclusions:

Cortisonic glaucoma and keratoconus is a rare association leading to a therapeutic problem. The management is complicated, but must be reasoned in order to preserve the visual acuity of these young patients.

Financial Disclosure:

None