Posters

Glaucoma in eyes after radial keratotomy: case report

Poster Details

First Author: M.Pomorska POLAND

Co Author(s):    O. Fuchs   R. Krecichwost   M. Misiuk-Hojlo              

Abstract Details

Purpose:

We present a patient with a history of previous bilateral radial keratotomy (RK) who was diagnosed with glaucomatous neuropathy years after RK surgery. The difficulties of glaucoma management in post RK eyes are discussed.

Setting:

A 57-year-old female 18 years after bilateral RK was consulted in Outpatient Ophthalmology Department of Wroclaw Medical University, Poland. She was complaining of gradual worsening of vision, particularly in her left eye. She has not been followed up by eye specialist during the last 10 years.

Methods:

Patient’s refraction was +1.00 -1.25 x 76 in her right eye (OD) and +1.00 -2.50 x 87 in the left eye (OS) and visual acuity 0.3 and 0.2 (Snellen), respectively. Automated keratometry and corneal topography were performed with similar average K values of 37.55 D OD and 35.13 D OS. Intraocular pressure (IOP) measured with Goldmann Applanation Tonometer (GAT) was 25 mmHg in OD and 27 mmHg in OS. The values from GAT were verified by Ocular Response Analyzer (ORA) testing resulting with bigger IOP values.

Results:

Fundus examination revealed glaucomatous neuropathy with the narrowing of the inferior neural rim of left optic disc. The diagnosis was confirmed with SOCT imaging and visual field testing. Average RNFL thickness was 94µm in OD and 78µm in OS. Standard Automated Perimetry result was normal in OD, but revealed glaucomatous damage in OS with MD value of – 10.07 dB . The antiglaucoma therapy was initiated. Surgical glaucoma treatment was considered due to high initial IOP values. However, currently, the patient is unwilling to undergo any surgical treatment.

Conclusions:

All eyes after refractive surgery, especially high myopic eyes, are at risk of developing glaucoma over time, therefore patients should be closely followed up. All patients planned for refractive procedure should undergo a thorough glaucoma work-up. IOP recordings may be affected by altered corneal properties, however recent development in tonometry such as ORA helps to overcome these limitations. The use of optic disc imaging modalities and visual field testing is also highly recommended in patients’ monitoring.

Financial Disclosure:

None