Challenges in Managing Secondary Glaucoma Post-Repeat Penetrating Keratoplasty in a Developing Country

Abstract

Purpose

To illustrate the complexity in managing secondary glaucoma post-repeat penetrating keratoplasty in a developing country.

Case Description

A patient with a history of five repeat penetrating keratoplasties (PKPs) showed good intraocular pressure (IOP) control with trabeculectomy; however, blebitis occurred as an undesirable complication. Trabeculectomy was done rather than tube implantation due to socioeconomic factors, although it’s not an ideal treatment. After the infection subsided, we performed a bleb revision with a scleral patch graft. Intraocular pressure was high in the follow-up period after the scleral patch, therefore we decided to do tube implantation. Following glaucoma tube implant surgery, the patient had good IOP control and a clear graft after six months of follow-up.

Conclusion

Secondary glaucoma post repeat PKPs is challenging in both diagnosis and management. Immediate action is imperative to control IOP, prevent glaucoma progression, and minimize corneal graft damage. In addition to medical reasons, socioeconomic factors should be considered.

Keywords:

• repeat penetrating keratoplasty
• secondary glaucoma
• blebitis
• tube implant

Abbreviations

BCVA, best-corrected visual acuity; IOP, intraocular pressure; 5-FU, 5 fluorouracil; MMC, mitomycin C; PAS, peripheral anterior synechiae; PKP, penetrating keratoplasty.

Ethics Approval and Informed Consent

Review and approval for the case report study were approved by the internal review ethics board of Jakarta Eye Center. The patient has been informed and given her consent to publish the data.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding support for this case report.