Abstract
Purpose
To evaluate the efficacy of cyclodialysis-enhanced Mitomycin c (MMC) trabeculectomy in post-keratoplasty glaucoma.
Design
Prospective, non-comparative, interventional case series.
Methods
A total of 45 eyes of 45 consecutive patients with refractory glaucoma after penetrating glaucoma underwent a cyclodialysis-augmented trabeculectomy with MMC. The visual acuity, intraocular pressure (IOP), corneal clarity, and graft failure were evaluated over a minimum follow-up of 2 years.
Results
The mean age of the patients was 55.4±9.4 years. The cyclodialysis-augmented MMC trabeculectomy procedure resulted in a mean reduction of IOP from 38.9±3.9mmHg (95% confidence interval (CI) 35.9–42.2) at baseline to 11.3±2.8mmHg (95% CI 9.5–12.9), at final follow up (P=0.002). Blebs were avascular, diffuse, and extended posteriorly. Postoperative UBMs revealed the presence of a cyclodialysis with a small associated suprachoroidal effusion and a subconjunctival filtering bleb in all cases.
Conclusions
Cyclodialysis-augmented MMC trabeculectomy provides a safe and effective method of lowering IOP in intractable glaucoma following penetrating keratoplasty, without compromising the corneal graft survival and clarity.
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References
Ayyala RS . Penetrating keratoplasty and glaucoma—major review. Survey Ophthalmol 2000; 45: 91–105.
Gilvarry AME, Kirkness CM, Steele ADM, Rice NS, Ficker LA . The management of post keratoplasty glaucoma by trabeculectomy. Eye 1989; 3: 713–718.
Ishioka M, Shimazaki J, Yamagami J, Fujishima H, Shimmura S, Tsubota K . Trabeculectomy with mitomycin C for post-keratoplasty glaucoma. Br J Ophthalmol 2000; 84: 714–717.
Wu Dunn D, Alfonso E, Palmberg PF . Combined penetrating keratoplasty and trabeculectomy with mitomycin C. Ophthalmology 1999; 106: 396–400.
Kwon YH, Taylor JM, Hong S, Honkanen RA, Zimmerman MB, Alward WL et al. Long term results of eyes with penetrating keratoplasty and glaucoma drainage tube implant. Ophthalmology 2001; 108: 272–278.
Arroyave CP, Scott IU, Fantes FE, Fener WJ, Murray TG . Corneal graft survival and intraocular pressure control after penetrating keratoplasty and glaucoma drainage device implantation. Ophthalmology 2001; 108: 1978–1985.
Ayyala RS, Pieroth L, Vinals AF, Goldstein MH, Schuman JS, Netland PA et al. Comparison of mitomycin C trabeculectomy, glaucoma drainage device implants and laser neodymium YAG cyclophotocoagulation in the management of glaucoma after penetrating keratoplasty. Ophthalmology 1998; 105: 1550–1556.
Foulks GN . Glaucoma associated with penetrating keratoplasty. Ophthalmology 1987; 94: 871–874.
Sedan J . On excessive hypotony following cyclodialysis. Bull Soc Ophthalmol Fr 1966; 66 (10): 959–971.
Vorosmarthy D . Prophylactic measures for the lessening of the risk of haemorrhage in cyclodialysis. Klin Monatsbl Augenheilkd 1966; 148 (3): 369–374.
Johnson EC, Cepurna WO, Jia L, Morrison JC . The use of cyclodialysis to limit exposure to elevated intraocular pressure in rat glaucoma models. Exp Eye Res 2006; 83 (1): 51–60.
Insler MS, Cooper HD, Kastl PR . Penetrating keratoplasty with trabeculectomy. Am J Ophthalmol 1985; 100: 593–595.
Figuerido RS, Araujo SV, Cohen EJ, Rapuano CJ, Katz LJ, Wilson RP . Management of coexisting corneal disease and glaucoma by combined penetrating keratoplasty and trabeculectomy with mitomycin C. Ophthalmic Surg Lasers 1996; 27: 903–909.
Alvarenga LS, Mannis MJ, Brandt JD, Schwab IR, Lim MC . The long term results of keratoplasty in eyes with a glaucoma drainage device. Am J Ophthalmol 2004; 138: 200–205.
Binder PS, Abel Jr R, Kaufman HE . Cyclocryotherapy for glaucoma after penetrating keratoplasty. Am J Ophthalmol 1975; 79: 489–492.
Kirkness CM, Ling Y, Rice NS . The use of silicon drainage tubing to controls post-keratoplasty glaucoma. Eye 1988; 2: 583–590.
Shah P, Lee GA, Kirwan JK, Bunce C, Bloom PA, Ficker LA et al. Cyclodiode photocoagulation for refractory glaucoma after penetrating keratoplasty. Ophthalmology 2001; 108: 1986–1991.
Jordan JF, Dietlein TS, Dinslage S, Luke C, Konen W, Krieglstein GK . Cyclodialysis ab interno as a surgical approach to intractable glaucoma. Graefes Arch Clin Exp Ophthalmol 2007; 245: 1071–1076.
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Sihota, R., Srinivasan, G. & Gupta, V. Ab-externo cyclodialysis enhanced trabeculectomy for intractable post-penetrating keratoplasty glaucoma. Eye 24, 976–979 (2010). https://doi.org/10.1038/eye.2009.282
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DOI: https://doi.org/10.1038/eye.2009.282
