Good Hope, Heartlands, and Solihull Eye Clinics

Corneal graft care, including glaucoma

 

David Kinshuck

 

Sutures

  • when sutures break, remove broken suture, but need dexamethasone cover, eg Maxidex x6 reducing

Glaucoma and grafts

  • Glaucoma increases risk of graft failure..endothelial failure.
  • Something about glaucoma damages endothelium.
  • Posterior polymorphous corneal dystrophy, is linked to glaucoma
  • Tgfbeta is raised in glaucoma, and this transform the endothelium.
  • Post keratoplasty (graft) glaucoma, 18%, probably due to lack of support for schlemms canal
  • Iop measurement, use  goldman, icare, fingers
  • Steroid response, ? Switch to fml after a while,
  • Cyclosporine does not work, consider stopping steroids if graft ok, Trsuopt ok,
  • Cyclodiode don't use as it  creates a poor surface & inflammation etc
  • have to operate, tubes lower iop, but cornea fails
  • Glaucoma surgery before graft
  • Topical tacrolimus helps prevent rejection Eye 20


Failed graft ..when to regraft

  • Regraft if no previous rejection ie just endothelial failure, no steroid response  and no glaucoma 
  • Endothelial transplant if stroma clear
  • if aim comfort only, conjunctival flap

Rejection treatment

  • Eye 20
  • subconjunctival dexamethasone 4mg/ml or triamcinolone 40mg/ml, with topical prednisolone 1% hourly for 24 hours was superior to 500mg methylprednisolone