Posters

Glaucoma and corneal transplant in pseudophakic patients: two connected entities in anterior segment complex surgical pathology – personal review

Poster Details

First Author: M.Iliescu ROMANIA

Co Author(s):    O. Moraru   C. Moraru                 

Abstract Details

Purpose:

Pseudophakic patients with endothelial decompensation, due to an eventful cataract surgery or a poor phacoemulsification technique, referred for corneal transplant, are complex cases, sometimes asociated with posterior capsule break, vitreous prolapse and coexisting glaucoma. They have either a posterior chamber (PC) intraocular lens (IOL) or a pupilar or anterior chamber (AC) IOL. Due to corneal pathology, reliable intraocular pressure (IOP) measurement cannot be performed and optic nerve and retinal assesment is difficult. Nevertheless, good glaucoma control is mandatory before and after any type of corneal transplant. This study is a review of our pseudophakic corneal transplant cases asociated with glaucoma.

Setting:

Oculus Eye Clinic – Bucharest, Romania

Methods:

We evaluated all pseudophakic patients operated for corneal transplant in the last 2 years in our clinic that had also preexisting glaucoma or developed it posttransplant. We divided them into two groups: PC, well positioned IOL group and pupilar or anterior chamber IOL group that needed also IOL exchange (triple procedure). Each group was subdivided into preexisting glaucoma (compensated, either medically or surgically) and postransplant secondary glaucoma subgroups. The corneal transplant techniques were Penetrating Keratoplasty, or Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty. Patients were evaluated pre and posttransplant (at least 6 months of follow-up) and glaucoma management was tailored individually.

Results:

We had 52 pseudophakic cases with corneal pathology and glaucoma. 35 eyes (67,31%) had PC IOLs and 17 (32,69%) had pupilar or AC IOL. In the first group, 7 eyes (20%) developed glaucoma posttransplant (compensated medically) and 28 eyes (80%) had prexisting glaucoma (23 eyes remained compensated after corneal surgery, and 5 eyes needed glaucoma surgery at a later stage). In the second group, 7 (41,17%) eyes developed glaucoma post triple procedure and 10 (58,83%) eyes had preexisting compensated glaucoma. In this second group, 12 eyes remained medically controlled and 5 eyes needed glaucoma surgery later, due to uncontrolled IOP.

Conclusions:

In eyes with corneal transplant, uncontrolled IOP endanger the endothelium and, the more complex the preop pathology, the higher the risk for developing glaucoma, or for decompensation of a pre-existing glaucoma. Both our groups included patients with pre-existing compensated glaucoma, or with glaucoma developped posttransplant. In both groups we encountered patients with decompensated glaucoma after transplant, which needed surgery. We could not find any statistical significant difference between groups in terms of risk for glaucoma decompensation and surgery, although the eyes with triple procedure imply surgical difficulties and a higher tendency for bleb failure, due to tissues changes and fibrosis.

Financial Disclosure:

None