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

Dear Doctor,
Thanks for the mail, I am sending it to Glaucoma Expert for their opinion and get back to you. Thanks.

Dear Dr Sarveswara Rao

We should prefer to do a Diode Cyclophotocoagulation as the visual prognosis of the Eye is very poor. It can be done at any facility where there is a Diode Laser.
One needs to buy a G Probe for the same procedure.
Request you kindly read the Instructions and carry that out .. It is a simple procedure and can be done under peribulbar anaesthesia.

Pls let me know for any queries ..

Regards


Dr Kalyani Prasad
P - 9849073754

Thanks, Dr Kalyani. I too had come to that conclusion. For one, long standing blind eye, distinct PAS, aphakia, she is most likely to have some amount or neovascularisation, unfortunately invisible on account of the totally opaque cornea; likelyhood of vitreous in anterior chamber, earlier vitrectomy at AC IOL explantation notwithstanding which would then present itself at the trab site. However, "SHANKHAM TO POSTENE TEERTHAM". Thanks, Dr Kalyani. And Dr Anil for patiently wading through our typescripts.
srt

One question is unanswered: Who else in Hyderabad other than LVPEI has this diode cyclophotocoagulator?

Dear Dr

Can you kindly check out at Centre for Sight (CFS) at Road No 2 Banjara Hills . They should be having that .
040- 40045500 is their LL number.


Regards


Kalyani