PENETRATING KERATOPLASTY WITH A VALVED GLAUCOMA DRAINAGE IMPLANT FOR CONGENITAL GLAUCOMA AND CORNEAL SCARRING SECONDARY TO HYDROPS

The simultaneous management of glaucoma and corneal opacification is s ometimes required in infants with severe congenital glaucoma if timely visual rehabilitation is to be achieved. A 1-month-old female infant presented with an enlarged, protuberant, opaque cornea in each eye and elevated intraocular pressure. An intrastromal, fluid-filled cleft wa s noted in both corneas. It resolved over 3 weeks as corneal scarring progressed. Peripheral corneal clearing allowed a view of an essential ly normal anterior chamber. Penetrating keratoplasty and Ahmed (New Wo rld Medical Inc., Rancho Cucamonga, CA) valve implant surgery with mit omycin-C were performed simultaneously in the two eyes 1 month apart. At 15 months of age, the patient's grafts were clear and the intraocul ar pressure was well controlled in both eyes. One eye required multipl e procedures for eventual glaucoma control. No postoperative overfiltr ation occurred. The authors conclude that the use of a valved implant should be considered in patients who require urgent simultaneous corne al and glaucoma surgery for severe congenital glaucoma. This combinati on may improve early postoperative control of aqueous outflow and posi tively affect long-term graft survival in these difficult cases.