congenital glaucoma, aphakia and bullous keratopathy managed with iol removal, pk, shunt & iris...
TRANSCRIPT
CONGENITAL GLAUCOMA, APHAKIA AND BULLOUS KERATOPATHY
MANAGED WITH IOL REMOVAL, PK, SHUNT & IRIS CLAW IOL
(QUADRUPLE)
Dr Harshavardhan GhorpadeMS, DNB, FRCS(Glasgow), FICO, FCOS
Fellowship Cornea and Ocular surface, Nottingham, UK and Ghent, Belgium.
Director, DOVS, Fortis Hospital, Vashi, Navi MumbaiConsultant Cornea and Refractive /Director, Cornea transplant services ,
Director ,Saroj Specialty Eye Clinic, Vashi, Navi Mumbai
Prof. Dr Sunil Moreker, MSConsultant, Oculoplasty and Glaucoma.
DOVS, Fortis Hospital, Vashi, Navi MumbaiCPD /CME committee member, International Council of Ophthalmology.
Clinical History A 25 year old male, case of Primary
Congenital Glaucoma Left eye phithisical since childhood Right Eye operated for Cataract and
Glaucoma surgery 5 years back Complaint of pain, poor vision, watering Vision CF 1m
Examination and initial management
Bullous Keratopathy with haptic touching endothelium, broad iridectomy
IOP 32, Optic disc shows pallor 0.7 deep cup
Vitreous in pupillary area
Operated for IOL explantation, vitrectomy and Trabeculectomy with MMC
Vision improves to 6/60 with +7.0 IOP 14
2 years later Patient has similar complaints Vision dropped to 3 m BK worsened IOP rises to 24 Kept on Travocom, lubricants Planned for PK with Shunt and secondary
IOL Patient very keen and strong willed
Pre Op Picture
BK and Aphakia
Surgery Extremely risky: Possibilities of white out,
expulsion and endoph explained to this one eyed man
General anaesthesia Flieringa ring Host tissue removed, quick implantation of Iris
claw lens avoiding the area of BI Donor graft sutured Shunt surgery performed with Aadi implant, Consolidated with scleral flap and 8-0 Ethilon IOL power calculated approx wrt his axial length
Glaucoma Valve seen with corneal transplant
Shunt Bleb
Graft & Iris Claw IOL
Follow up.. Day 21 Vision 6/60 IOP 11 No choroidals INR 2.2 Patient happy but with flashes IO examination shows HST! Lasered with great effort as cornea has
edema and patient has photophobia and pupil limited in size by lens
Post op 3 months Cornea clear IOP 12 Lens in situ AC slightly shallow Vision 6/18 BCVA Expected to improve further after suture
adjustments and RGP if necessary Warfarin dose reduced as patient had purpura