|Year : 1982 | Volume
| Issue : 5 | Page : 437-439
Therapy of glaucoma following keratoplasty
Guru Gobind Singh International Eye Centre, New Delhi, India
Guru Gobind Singh, International Eye Centre, Bank Street Karol Bagh, New Delhi-110005
|How to cite this article:|
Singh G. Therapy of glaucoma following keratoplasty. Indian J Ophthalmol 1982;30:437-9
One of the most tragic complications following corneal grafting is glaucoma. The aim of present communication is to present results of medical therapy, punch trabeculectomy and cyclocryotherapy in 100 such cases.
| Materials and methods|| |
The study includes 100 cases of glaucoma following keratoplasty. The size of the graft in these cases were 7.5 mm-I0 cases; 8 mm15 cases; 8.5 Inm-15 cases; 9 mm-20 cases 9.5 mm-20 cases; and 10 mm-20 cases. The ages of the patients arranged between 4 years to fifty years. The indications of keratoplasty in these cases were following :
1. Therapeutic keratoplasty -80 cases
(a)-Bacterial -20 cases
(b)-Mycotic -20 cases
(c)-Viral -20 cases
2. Cosmetic keratoplasty 10 cases
3. Optical keratoplasty 10 cases
In the post operative period the dressing of the cases were carried out using soframycin Eye drops and Atropine Eye drops. The study was divided into three groups.
1. Medical Therapy
3. Punch Trabeculectomy
All the cases received in the post operative period systemic diamox (acetazolmide) in dose of 250 mg. 8 hourly.
| Observations|| |
1. Medical Therapy : This was instituted in all the cases and was in the form of Oral diamox, glycerol and even Intravenous administration of 25% Dextrose or Unimannitol. The cases which had small anterior synechia were subjected to anterior synechiotomy. As seen in [Table - 1] the causative factors in these cases were Air Behind Iris- 13 cases, Too much air in vitreous-5 cases, Iritic glaucoma-10 cases and small Anterior Synechia-24 cases. All the cases responded to the treatment except 10 cases due to anterior synechia.
2. Cyclocryo therapy : This group comprised of 10 cases which were unsuccessful with Medical Therapy and an additional cases which were due to dense anterior synechia, dense vascularation between graft edge in aphakics. This procedure was successful in 88% of the cases synechia group and 66.7% of the ring synechia group.
The Cyclocryotherapy was performed using about 10 spots of Cryo probe at a distance of 3mm to 6.5mm from the Limbus. Each spot was placed at an interval of 2mm. The Cryo probe was placed for 1 minute at each place. If second sitting was given to any case it was not before a period of 2 weeks. After two weeks the Cryo Applications were repeated at the same site as the previous one. In certain cases 3-4 applications at the same site were carried out. Post operative complications in these cases were burning and irritation in all cases for 2-3 days after the Cryo Applications.
3. Punch Trabeculectomy : This was carried out in 14 cases which did not respond to . the Cyclocryotherapy. The Intraocular tension in these cases ranged between 25-40mm Hg. It was seen that 80% of the cases got controlled with this technique. In rest of the cases the graft became opaque. The complications which were seen in this group were bleeding into the vitreous from the adhesions of the cornea.
| Discussion|| |
Medical Therapy in the form of systemic diamox and intravenous mannitol solution is good to control intraocular tension in cases which are due to too much air in the vitreous as happen in aphakics.
In cases of anteror synechia and graft ring synechia medical therapy has a temporary effect. However, sequential Cyclocryotherapy is able to control 66.7% and 88% of the cases. This method is free of complications like Hyphaema as seen after other Surgery.
In cases of where Cyclocryotherapy also failed were subjected to punch trabeculectomy. 'This procedure was successful in 80% of the cases. The complications were mere and were in the form of bleeding into the vitreous and iritis.
Review the various lines of Management it appears that sequential Cyclocryotherapy is the safe procedure in these cases.
| Summary|| |
It has been seen in 100 cases of post kerotoplasty glaucoma that medical Therapy is able to control only is a small group of cases. The other group of cases which is due to anterior synechia or ring synechia are best amenable to the Cyclocryotherapy.
| References|| |
|1.||Cairns, J.E., 1968, Amer. J. Ophthalmol. 66:673. |
|2.||Gurbax Singh, Bhinder G.S. and Sanghi, 1979, Ind. J. Ophthalmol. 27:109. |
[Table - 1], [Table - 2], [Table - 3]