MANAGEMENT OF MALIGNANT GLAUCOMA AFTER DESCEMET STRIPING AUTOMATED KERATOPLASTY
Published 2025 - 29th ESCRS Winter Meeting
Reference: PO239 | Type: Case Report (Cornea Day) | DOI: 10.82333/bet1-bt20
Authors: Monika Sarnat-Kucharczyk 1 , Lukasz Drzyzga 2 , Ewa Mrukwa-Kominek* 3
1Department of Ophthalmology,Faculty of Medical Science, Medical University of Silesia,Katowice,Poland;Department of Ophthalmology,University Clinical Center, Medical University of Silesia,Katowice,Poland, 2Department of Ophthalmology,University Clinical Center, Medical University of Silesia,Katowice,Poland;Ophthalmology,Okolux Center,Katowice,Poland, 3Department of Ophthalmology,Faculty of Medical Science, Medical University of Silesia,Katowice,Poland;Department of Ophthalmology,University Clinical Center, Medical University of Silesia,katowice,Poland
Purpose
The aim is to describe a case of 67-years-old female with malignant glaucoma after Descemet Striping Automated Keratoplasty (DSAEK) due to trapped gas bubble behind the iris and to present problem solving pathway in the management of this complication and the intraocular pressure (IOP) rise.
Setting
Department Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Report of case
Uncomplicated DSAEK in the right eye was performed in 75-years-old female with Fuchs’ endothelial keratopathy. At the and of the surgery anterior chamber in 80% was filled with mixture of SF6 and air.
12 hours after surgery patient complained about severe ocular pain and headache. Intraocular pressure was 50 mmHg. In slit lamp examination anterior chamber (AC) was very shallow with peripheral iridocorneal contact and reduced gas bubble to 10% of the AC. The lower edge of the trapped gas was noticed behind the iris in slit lamp examination. Topical and systemic antiglaucoma medications, cycloplegic did not decrease IOP. In the operating theatre trapped bubble was removed with needle, peripheral irido-corneal adhesions were lysed with a flush of basic salt solution. At the end of the surgery filtered air was injected into filling 70% of AC. IOP was 16 mmHg. Iris regained its normal anatomy configuration. During and after surgery grafted remained attached to host cornea. In the post-surgical period and 3 months follow-up increased thickness of the graft and host cornea was noted without any signs of graft rejection, which may indicate endothelial cell damage due to highly increased IOP in the early postoperative period
Conclusion / Take home message
Although rare, malignant glaucoma may occur after DSAEK. If not recognized promptly, the graft endothelium can become damaged and peripheral anterior synechiae can form.
Management of this complication may induce other problems such as endothelial cell loss, graft detachment and/or rejection.
Early recognition and immediate surgical treatment is essential in prevention of visual acuity loss and graft failure such as endothelial cell loss, graft detachment and/or rejection.
Recommended preventive measures include preoperative or intraoperative iridotomy, placement of a freely mobile air bubble that does not fill the entire anterior chamber and the use of cycloplegics and mydriatic eye drops