Combination therapy in the patient with glaucoma and endothelial corneal dystrophy treatment: clinical case

Background. Penetrating keratoplasty improves visual acuity in patients with various corneal conditions. However, like any form of surgery it can lead to complications and there are number of contraindications. Uncompensated glaucoma is one of the poor prognostic factors for penetrating keratoplasty. Penetrating keratoplasty can result in postoperative reactive hypertension, although it is not a common condition. This complication is associated with glaucoma patients whereas patients who has not been previously diagnosed with glaucoma suffer from postoperative reactive hypertension much less. Increased intraocular pressure in glaucoma patients can lead to disease progression and graft failure. Clinical case description. This clinical case presents a juvenile glaucoma patient, who underwent surgery for glaucoma several times and after that underwent the EX-PRESS glaucoma filtration device implantation. The EX-PRESS device contacted with the posterior surface of the cornea that resulted in endothelial corneal dystrophy development with corneal opacities and pain. The EX-PRESS device was removed and penetrating keratoplasty was performed, since critical flicker frequency was high (30 Hz), so that a sufficiently good visual outcome was expected. However, despite the maximum medical therapy in glaucoma, intraocular pressure remained high, so transscleral diode laser cyclophotocoagulation had been applied. Conclusion. The clinical case demonstrates the effectiveness of transscleral diode laser cyclophotocoagulation in the patient with repeatedly operated refractory glaucoma before penetrating keratoplasty.

Key words: clinical case, transscleral diode laser cyclophotocoagulation, refractory glaucoma, juvenile glaucoma, intraocular pressure, penetrating keratoplasty.

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