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B. M. Shah, H. Shekhar, N. Bansal, A. Panda, M. Vanathi, T. Dada; Anterior Segment OCT Imaging in Opaque Grafts With Secondary Glaucoma Following Therapeutic Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5537.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the anterior segment in opaque grafts with secondary glaucoma following therapeutic penetrating keratoplasty performed for perforated corneal ulcers by using anterior segment optical coherence tomography (ASOCT).
In this cross-sectional observational study, eyes with opaque corneal grafts (iris details not visible on slit lamp biomicroscopy) following therapeutic keratoplasty with non-optical grade donor corneas underwent ASOCT examination using VISANTE (Carl Zeiss Meditec, Dublin, CA). All the patients had undergone a therapeutic penetrating keratoplasty for management of perforated corneal ulcer and eyes with intraocular pressure (IOP) > 25 mmHg on two or more occasions presenting 3 months or more post surgery were included. Examination included slit-lamp biomicroscopy, IOP measurement using Tonopen AVIA ( Reichert, Depew, NY), and ASOCT evaluation of the anterior segment using the quad scan protocol (four limbus to limbus scans of the irido-corneal angle 45 degrees apart and one central scan).
Fifteen eyes of 15 patients with post penetrating keratoplasty glaucoma were evaluated. The mean age of the patients was 40.6 ± 13.8 years (range, 16-55 years). The mean intraocular pressure at presentation was 35.1 ± 8.6 mm Hg (range, 26 - 46 mm Hg). The mean duration of follow-up after penetrating keratoplasty was 12.4 ± 4.2 months (range, 6 - 18 months). The types of synechiae noted on the ASOCT included peripheral anterior synechiae in all 15 eyes (100%), synechiae at the graft-host junction in 6 eyes (40%), central iridocorneal synechiae in 4 eyes (26.6%). Six eyes were aphakic and 9 eyes were phakic. In eyes with peripheral anterior synechiae, the extent of angle closure was 180-2700 in 2 eyes (13.3%) and 270-3600 in 13 eyes (86.6%).
ASOCT serves as a useful tool for evaluation of the anterior segment in eyes with opaque grafts with secondary glaucoma following therapeutic keratoplasty performed for perforated corneal ulcers. Angle closure due to peripheral anterior synechiae formation is the primary mechanism for IOP elevation in such cases.
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