Case report demonstrates targeted early MGS intervention prevents vision loss from angle closure after corneal transplant, suggesting timely surgical referral is crucial.
Aim and background: To report a case in which a targeted early minimally invasive glaucoma surgery (MIGS) approach successfully prevented irreversible sight loss from acute secondary angle closure following tectonic penetrating keratoplasty (PKP) in an eye with a prior porcine-derived corneal stromal implant (Xenia®) as treatment for advanced keratoconus.Case description: The authors describe successful surgical treatment of a patient who developed acute intraocular pressure (IOP) elevation following tectonic PKP for perforated bacterial microbial keratitis.We demonstrate that combined goniosynechialysis (GSL) and iStent Inject® trabecular micro-bypass implantation are effective in reversing postoperative synechial angle closure, restoring angle integrity, and preventing progressive glaucomatous optic neuropathy and, thus, irreversible sight loss in an eye with a functioning PKP. Conclusion:The authors highlight the importance of early recognition and referral to a glaucoma specialist for prompt mechanism-targeted MIGS to manage postkeratoplasty secondary angle closure.Clinical significance: Early targeted MIGS intervention may prevent the need for complex glaucoma filtration surgery in eyes with secondary synechial angle closure following corneal transplant surgery.
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Kanj et al. (2026) studied this question.
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