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Corneal Graft Followed By Enhanced Medical Therapy Or Trabeculectomy

Corneal Graft Followed By Enhanced Medical Therapy Or Trabeculectomy. Dr A. Barbara Dr R. Nesher A.Pichkhadze; M. Matanes Swidan; I.Piven; N. Chetrit; M. Ashhab. The Dilema. Trab first. Graft first. The Diagnosis of Glaucoma is questionable!!!. Is the elevation of IOP real?

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Corneal Graft Followed By Enhanced Medical Therapy Or Trabeculectomy

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  1. Corneal Graft Followed By Enhanced Medical Therapy Or Trabeculectomy Dr A. Barbara Dr R. Nesher A.Pichkhadze; M. Matanes Swidan; I.Piven; N. Chetrit; M. Ashhab

  2. The Dilema Trab first Graft first

  3. The Diagnosis of Glaucoma is questionable!!! • Is the elevation of IOP real? • Is the C/D of 0.5 pathological? • Is there an abnormal VF?

  4. Is the elevation of IOP real…. • Corneal thickness may lead to over or under estimation of IOP up to 12 mm • (Whitacre Am J of Ophthalmology 1993 115: 59 ) • IOP by Goldman applanation tonometry varied up to 17 mm with changes in corneal elasticity even if corneal thickness remained constant • ( Liu J- J of cataract & refractive surgery2005 : 31;146- 154) • Dense disciform scar can change both corneal thickness and elasticity

  5. The Diagnosis of Glaucoma is questionable!!! • Is the elevation of IOP real? • Is the C/D of 0.5 pathological? • Is there abnormal VF?

  6. The Diagnosis of Glaucoma is questionable!!! • Is the C/D of 0.5 pathological? • Direct ophthalmoscopy • non -Gaussian distribution 1-2% > 0.7 • Stereoscopic view • Gaussian distribution mean is 0.4 and 5% with C/D 0.7 • Schwartz Br J Ophthalmol 59; 216 1975

  7. The Diagnosis of Glaucoma is questionable!!! • Is the elevation of IOP real? • Is the C/D of 0.5 pathological? • Is there abnormal VF?

  8. Why not trabeculectomy first.. Even if Glaucoma is present, still we do not recommend trabeculectomy first, because: There is increased incidence of bleb failure following ocular surgery: both after cataract and cornea surgery

  9. Why not trabeculectomy first.. • There is increased risk to develop blebitis.

  10. Why not trabeculectomy first.. • There is increased risk for reactivation of herpetic keratitis • steroid therapy • surgical trauma inducing stress

  11. PKP first - PREFERRED option • Corneal graft will restore vision to the patient • Will enable us to confirm or rule out glaucoma • Status of the optic nerve head and RNFL • VF • In case of glaucoma MTMT is still an option

  12. 1st 2nd 3rd TRABEC GRAFT REPEATED TRABEC? GRAFT TRABEC?

  13. Thank you

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