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    Pre-existing glaucoma poses considerations for corneal procedures

    Patients may be at higher risk for elevated IOP, may require surgical treatment in some cases

    Charlottesville, VA—Patients with pre-existing glaucoma are at high-risk for elevated IOP after a corneal surgery and require special considerations preoperatively to avoid potential disasters.

    Peter A. Netland, MD, PhD, presented various surgical options and the optimal order in which they should be performed to achieve the maximal visual outcomes for these patients.

    He described the case of a patient who had pre-existing glaucoma and who developed elevated IOP and lost vision after Descemets stripping endothelial keratoplasty (DSEK) performed in the left eye. The treatment was implantation of a glaucoma filtration device (EX-PRESS, Alcon Surgical) under a partial-thickness scleral flap. The patient then needed corneal surgery in the right eye and planning glaucoma therapy in that eye was important to avoid decreased vision as occurred in the fellow eye.

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    Pre-existing glaucoma is a risk factor for elevated IOP and secondary glaucoma after both penetrating keratoplasty (PK) and DSEK.

    “In patients who do not have pre-existing glaucoma, about 20% develop increased IOP,” said Dr. Netland, the Vernah Scott Moyston Professor and Chair, Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA. “However, in patients who have pre-existing glaucoma, 55% develop increased IOP.”

    More cornea: Keratoconic eye experience with a long-arc intrastromal corneal ring

    A number of factors can be involved in the elevated IOP after PK, according to Dr. Netland. These include peripheral anterior synechiae formation and angle closure, a distorted anterior chamber angle and trabecular meshwork, pupillary block, a steroid response, iritis, and malignant glaucoma.

    However, the major factor in elevated IOP after DSEK is likely to be a steroid response.

    Related: Exploring balance of controlling inflammation, IOP in uveitis

    “These patients generally develop an open-angle glaucoma usually 1 to 3 months after DSEK is performed,” he said. “Most patients are treated medically, but some need surgery, especially those with pre-existing glaucoma.”

    Glaucoma surgical procedures

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