Surgical treatment of secondary glaucoma in comorbid pathology with subsequent penetrating keratoplasty (case study)

Abstract

PURPOSE. To evaluate the effect of surgical treatment of secondary glaucoma with subsequent end-to-end keratoplasty in a patient with aphakia, operated retinal detachment and condition after intrastromal keratoplasty.METHODS. A patient with secondary refractory glaucoma against the background of aphakia, a biopolymer implant in the corneal stroma, an inflammatory reaction to multiple surgical interventions (formation of anterior synechiae), operated retinal detachment was examined in the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery" in Moscow. The following treatment was performed: implantation of Ahmed valve drainage and pene-trating keratoplasty with implant removal.RESULTS. On the second day after implantation of Ahmed valve drainage on the right eye, intraocular pressure was normal in palpatory examination, the drainage tube in the anterior chamber was in the correct position. Three months after the operation, there were no complaints, intraocular pressure was normal in palpatory examination, there was a decrease in corneal edema. Penetrating keratoplasty was performed four months after the implantation of Ahmed valve drainage. On the second day after the operation, hypotension was noted with palpatory measurement of intraocular pressure, which persisted for five days. At patient discharge, the graft was adapted, the sutures were consistent, normal pressure with palpatory examination. During the observation period of up to three months, visual acuity increased to 0.1.CONCLUSION. To prolong the hypotensive effect and minimize intra- and postoperative complications in order to achieve the highest possible visual functions before performing optical reconstructive surgery, it is advisable to perform an anti-glaucoma intervention. In secondary refractory glaucoma caused by various factors, the choice of surgical treatment is always individual and depends on the severity of anatomical changes, the experience and capabilities of the surgeon, and often requires multi-stage treatment with continuous observation.