MANAGEMENT OF COEXISTING CORNEAL DISEASE AND GLAUCOMA BY COMBINED PENETRATING KERATOPLASTY AND TRABECULECTOMY WITH MITOMYCIN-C

BACKGROUND AND OBJECTIVE: The management of coexistent corneal disease and uncontrolled glaucoma continues to be a challenging clinical situ ation. The purpose of this study is to evaluate the results of combine d penetrating keratoplasty and trabeculectomy with mitomycin-C. PATIEN TS AND METHODS: A retrospective study was undertaken to review the rec ords of nine patients who had corneal edema and high intraocular press ure managed by simultaneous penetrating keratoplasty and trabeculectom y with mitomycin-C. RESULTS: The nine patients had an average preopera tive intraocular pressure of 26 mm Hg (range 17 to 41 mm Hg) and assoc iated corneal edema. The average postoperative intraocular pressure at last follow-up was 19 mm Hg (range 5 to 53 mm Hg). Three patients nee ded additional procedures. Six of nine patients had intraocular pressu res judged to be adequately controlled (11 +/- 5 mm Hg, range 5 to 18 mm Hg) throughout the postoperative period (average follow-up 16 month s). Grafts remained clear in seven patients. The grafts failed in two cases in which additional glaucoma surgery was necessary. CONCLUSION: Combined penetrating keratoplasty and trabeculectomy with mitomycin-C should be considered for selected patients with uncontrolled glaucoma and corneal disease who have sufficient conjunctiva for a filtering pr ocedure.