CONGENITAL GLAUCOMA, APHAKIA AND BULLOUS KERATOPATHY

MANAGED WITH IOL REMOVAL, PK, SHUNT & IRIS CLAW IOL

(QUADRUPLE)

Dr Harshavardhan GhorpadeMS, DNB, FRCS(Glasgow), FICO, FCOS

Fellowship Cornea and Ocular surface, Nottingham, UK and Ghent, Belgium.

Director, DOVS, Fortis Hospital, Vashi, Navi MumbaiConsultant Cornea and Refractive /Director, Cornea transplant services ,

Director ,Saroj Specialty Eye Clinic, Vashi, Navi Mumbai

Prof. Dr Sunil Moreker, MSConsultant, Oculoplasty and Glaucoma.

DOVS, Fortis Hospital, Vashi, Navi MumbaiCPD /CME committee member, International Council of Ophthalmology.

Clinical History A 25 year old male, case of Primary

Congenital Glaucoma Left eye phithisical since childhood Right Eye operated for Cataract and

Glaucoma surgery 5 years back Complaint of pain, poor vision, watering Vision CF 1m

Examination and initial management

Bullous Keratopathy with haptic touching endothelium, broad iridectomy

IOP 32, Optic disc shows pallor 0.7 deep cup

Vitreous in pupillary area

Operated for IOL explantation, vitrectomy and Trabeculectomy with MMC

Vision improves to 6/60 with +7.0 IOP 14

2 years later Patient has similar complaints Vision dropped to 3 m BK worsened IOP rises to 24 Kept on Travocom, lubricants Planned for PK with Shunt and secondary

IOL Patient very keen and strong willed

Pre Op Picture

BK and Aphakia

Surgery Extremely risky: Possibilities of white out,

expulsion and endoph explained to this one eyed man

General anaesthesia Flieringa ring Host tissue removed, quick implantation of Iris

claw lens avoiding the area of BI Donor graft sutured Shunt surgery performed with Aadi implant, Consolidated with scleral flap and 8-0 Ethilon IOL power calculated approx wrt his axial length

Glaucoma Valve seen with corneal transplant

Shunt Bleb

Graft & Iris Claw IOL

Follow up.. Day 21 Vision 6/60 IOP 11 No choroidals INR 2.2 Patient happy but with flashes IO examination shows HST! Lasered with great effort as cornea has

edema and patient has photophobia and pupil limited in size by lens

Post op 3 months Cornea clear IOP 12 Lens in situ AC slightly shallow Vision 6/18 BCVA Expected to improve further after suture

adjustments and RGP if necessary Warfarin dose reduced as patient had purpura