Subject(s)
Cataract/diagnosis , Eye Abnormalities/diagnosis , Glaucoma/congenital , Keratoconus/diagnosis , Microscopy, Confocal , Adult , Cataract/pathology , Diagnosis, Differential , Eye Abnormalities/pathology , Eye Abnormalities/surgery , Female , Glaucoma/diagnosis , Glaucoma/pathology , Glaucoma/surgery , Humans , Intraocular Pressure , Keratoconus/pathology , Keratoconus/surgeryABSTRACT
Penetrating keratoplasty (PKP) is associated with an increased risk of secondary glaucoma. The development of glaucoma after PKP is an important risk factor for decreased corneal graft survival. The incidence of glaucoma after corneal transplant as well as the mechanism of developing increased intraocular pressure is reviewed in this paper. Treatments for post-PKP glaucoma include medications, laser, and surgery. The most frequent surgical glaucoma intervention is implantation of a glaucoma-drainage device. Recent advances in corneal transplantation surgery may help to decrease corneal failure and the risk of developing post-keratoplasty glaucoma.
Subject(s)
Glaucoma/etiology , Glaucoma/therapy , Graft Rejection/prevention & control , Keratoplasty, Penetrating/adverse effects , Postoperative Complications/prevention & control , Glaucoma/epidemiology , Graft Rejection/etiology , Humans , Incidence , Intraocular Pressure , Keratoplasty, Penetrating/methods , Postoperative Complications/epidemiology , Risk Factors , TrabeculectomyABSTRACT
AIM: To analyse cases of recurrent ectasia in donor corneas after penetrating keratoplasty (PK) for keratoconus. METHODS: Data on 25 patients (36 eyes) with recurrent ectasia were retrospectively analysed in this study. The main outcome measures were time to development of recurrent ectasia after first PK for keratoconus, change in keratometric sphere and astigmatism between final suture removal and development of recurrent ectasia, status of regrafts for recurrent ectasia, and histopathology of grafts excised for recurrent ectasia. RESULTS: The age at first PK was 32.6 (SD 8.5) years, and ectasia developed 21.9 (7.0) years after PK. The mean keratometric sphere and cylinder increased by 4.2 D and 3.0 D, respectively, between final suture removal and diagnosis of recurrent ectasia. Ectasia was often preceded by thinning without bulging of the recipient stroma at the graft-host junction. Fifteen eyes (13 patients) were regrafted for recurrent ectasia, and histopathology of the excised grafts showed changes characteristic of keratoconus in the donor tissue in all cases. Two regrafts (two eyes of one patient) developed ectasia again, with one eye requiring a third PK to improve vision. CONCLUSIONS: Recurrent ectasia was diagnosed on average two decades after PK. Ectatic changes were often bilateral and occasionally recurred after regrafting, suggesting that host cellular and/or biochemical factors may be responsible. Repeat PK for recurrent ectasia is successful in the intermediate term.
Subject(s)
Keratoconus/surgery , Keratoplasty, Penetrating , Adult , Astigmatism/etiology , Cornea/pathology , Dilatation, Pathologic/etiology , Female , Humans , Keratoconus/pathology , Male , Middle Aged , Recurrence , Reoperation , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
We describe a free-floating cyst in the anterior chamber after cataract surgery in a 73-year-old woman who underwent uneventful phacoemulsification in her right eye (OD). The best-corrected visual acuity one week after surgery was 20/20 OD; however, six weeks later, she noted the onset of intermittent "shadows" in this eye whenever she changed head position. Slit lamp examination showed a round, free-floating, clear cyst (3-4 mm in diameter) that traversed the central visual axis during eye movement. The cyst was removed through a limbal incision, by expressing it gently out of the eye with viscoelastic injection into the anterior chamber. On pathological examination the inner wall of the cyst was lined with non-keratinized squamous epithelium, typical of ocular surface cells.
