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ד"ר ענת בכר, ד"ר אורן טומקינס , ד"ר איגור מינצר, ד"ר סרג'יו ניומן, ד"ר מעוז עמירן

ד"ר ענת בכר, ד"ר אורן טומקינס , ד"ר איגור מינצר, ד"ר סרג'יו ניומן, ד"ר מעוז עמירן. Iridocorneal Endothelial Syndrome. PROGRESSIVE IRIS ATROPHY. Proliferation of abnormal corneal endothelium Characteristics Middle age More common in females Unilateral Clinical signs Iris abnormalities

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ד"ר ענת בכר, ד"ר אורן טומקינס , ד"ר איגור מינצר, ד"ר סרג'יו ניומן, ד"ר מעוז עמירן

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  1. ד"ר ענת בכר, ד"ר אורן טומקינס, ד"ר איגור מינצר, ד"ר סרג'יו ניומן, ד"ר מעוז עמירן

  2. Iridocorneal Endothelial Syndrome PROGRESSIVE IRIS ATROPHY • Proliferation of abnormal corneal endothelium • Characteristics • Middle age • More common in females • Unilateral • Clinical signs • Iris abnormalities • Corneal edema • Elevated IOP CHANDLER’S SYN. COGAN-REESE

  3. TrabeculectomyWhy not? • Laganowski et al, Arch Ophthalmol 1992 • 22 Patients underwent trabeculectomy • Survival at 1yr- 60%, 2yrs- 40% • Success of repeated procedures- ~20% • Kidd et al, Arch Ophthalmol 1988 • 47 patients underwent trabeculectomy • Survival at 1yr- 64%, 3yrs- 40%

  4. TrabeculectomyWhy not? • Wright et al, Ophthalmology 1991 • 9 patients underwent trabeculectomy & post. Op. 5FU • 5 failures within 2-13 months • Doe et al, Ophthalmology 2001 • 12 patients underwent trabeculectomy & anti-metabolite • 73% survival at 1 year • 44% survival at 3 years • 29% survival at 5 years

  5. TrabeculectomyWhy not? • Causes of Failure • Endothelial membrane continued growth over the filtration site • Subconjunctival fibrosis(Laganowski et al, Arch Ophthalmol 1992)

  6. Drainage implantGo for it • Bypasses • ICE membrane regrowth over filtration ostium • Subconjunctival fibrosis over the filtration site

  7. Drainage implantGo for it • Kim et al, Ophthalmology 1999 • 10 patients underwent glaucoma drainage implant (GDI) • Success: IOP < 21 • IOP-lowering meds • Revision of tube • Failure: further glaucoma surgery • 90% success at 1 year • 70% success at 5 years

  8. Drainage implantGo for it Doe et al, Ophthalmology 2001 • 26 patients • 5 trab, 7 trab GDI, 14 GDI • Success: IOP ≤ 21, VA ≥ 20/400 • IOP-lowering meds • No. of medications- GDI (1.2±1.1) vs. Trab (2.3±0.8)

  9. Surgical Complications Tube vs. Trabeculectomy Study January 2007, AJO

  10. Contact lens after PKPHow can you manage it?

  11. Penetrating Keratoplasty • Shields et al, Ophthalmology 1979 • 49 of 90 patients developed corneal edema • IOP lowering relieved edema in most cases • Follow- up after PKP (Alvim et al, Cornea 2001; Buxton et al, AJO 1984; Crawford et al, Cornea 1989) • 28 patients • Mean follow-up time 48m • In all cases no evidence of recurrence of corneal abnormalities

  12. תודה קבוצה 3

  13. 3

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