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Cornea & Glaucoma

Cornea & Glaucoma. T. Lifshitz, J. Levy Department of Ophthalmology Soroka University Medical Center Beer-Sheva, Israel. Case report # 1. 92 year-old man BE Pseudophakic 10 years ago Old Trachoma - Trichiasis No Follow up LE 3 weeks prior admission – severe pain

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Cornea & Glaucoma

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  1. Cornea & Glaucoma T. Lifshitz, J. Levy Department of Ophthalmology Soroka University Medical Center Beer-Sheva, Israel

  2. Case report # 1 • 92 year-old man • BE Pseudophakic 10 years ago • Old Trachoma - Trichiasis • No Follow up • LE 3 weeks prior admission – severe pain • LE corneal abcess , melting, hypopion • Treatment – Vancomycin+ Ceftazidim – • Spontatious Perforation

  3. Case # 1 – cont’ • Histoacryl Glue Patch • Continuous leakage • Corneal Patch graft • VIDEO

  4. Case # 1 – cont’ • Melting of Patch graft • Hot Graft – PKP • VIDEO

  5. Case # 1 – Two Options: One day post-op: OPTION 1 If the eye is seen as in the photo: • RE IOP 42 mm Hg • Possible causes?

  6. Case # 1 – Two Options: One day post-op: OPTION 2 If the eye is seen as in the photo: : • RE IOP 42 mm Hg • OTHER causes?

  7. Case report # 2 • 74 year-old man • LE uneventful phaco surgery in 2008 • Postop LE BCVA 6/9

  8. Case # 2 – cont’ • In 2009 progressive bullous keratopathy • LE BCVA 6/60 • Rest of eye examination: normal

  9. Case # 2 – cont’ • September 2009: LE DSAEK • Pre-op IOP: 14 mm Hg (no treatment) VIDEO

  10. Case # 2 – cont’ One day post-op: • LE IOP 58 mm Hg !! • Other interesting findings at examination? • Etiology ?? • Treatment ??

  11. Case # 2 – cont’

  12. Case # 2 – cont’ Treatment: • Oral acetazolamide • Trusopt • Tiloptic • Alphagan BUT IOP still 40 mm Hg Other options ??

  13. Case # 2 – cont’ Two hours post-op: • Air removal from A/C paracentesis

  14. Case # 2 – cont’ One day post-op: • IOP 12 mm Hg

  15. Case # 2 – cont’ Other treatment options: • Pupillary dilation: • makes the pupil larger than the air bubble • moves the air forward and anterior to the iris • Air removal • Peripheral iridotomy • A/C reformation and viscodissection and separation of iridocorneal adhesions

  16. Case # 2 – cont’ Any special considerations after DSEK procedures? • WHEN to check IOP after the procedure? • WHAT to look at the slit-lamp examination? • HOW to prevent high IOP?

  17. Surv Ophthalmol 45:91–105, 2000

  18. Surv Ophthalmol 45:91–105, 2000

  19. Dada, Aggarwal, Panda; Indian J Ophthalmol 2008

  20. Dada, Aggarwal, Panda; Indian J Ophthalmol 2008

  21. Dada, Aggarwal, Panda; Indian J Ophthalmol 2008

  22. Thank you!

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