Aphakic Glaucoma dilemma
One more to keep my little grey cells working:
• Cataract surgery done April 2005. PC break, AC IOL implanted.
• A couple of episodes of raised IOP, pain, hence ACIOL explanted after 4 months.
• All quiet for the next eight years.
• Now presented again with bullous keratopathy, IOP in 50’s, no vision, cornea extensive leucoma. As of now, no pain, but pain is likely sooner rather than later
• Gross Anterior synechiae seen at limbus: iris adherence clearly seen.
• Question: In view of the virtual 360 degree peripheral anterior synechiae what is the next step:
• trab or transscleral laser diode cyclo photocoagulation?
• Literature is apparently skeptical of utility of trab in longstanding aphakic glaucoma.
• However, my question is Specifically would trab help in lowering IOP by at least couple of 10’s even in the presence of gross PAS so as to reduce chances of bullae and pain?
• What is the possible life span of a trab in such situations?
• Or should one recommend laser cyclodestruction as surgery of choice?
• If yes, does anyone in Hyderabad other than LVPEI have this machine?
Thanks
Sarveswara Rao Tekumalla