Management Challenge: A Case of Aniridia and Aphakia with Secondary Glaucoma in Sclerokeratoplasty

Abstract

A patient presented to us with post-infectious keratitis and a large anterior staphyloma in the left eye with vision as low as only the perception of light and accurately determining the projection of rays. A B-scan showed no abnormality in the posterior segment. Sclerokeratoplasty with an 11-mm graft with aniridia and aphakia was done. On 4 weeks of follow-up, intraocular pressure (IOP) was 39 mmHg on applanation tonometry, for which medical management was tried using a combination regime that was insufficient, following which a series of management approaches like trabeculectomy and Ahmed glaucoma valve (AGV) implant was done (in superotemporal quadrant). Unfortunately, recurrent exposures of the AGV tube were encountered, which were managed using different graft materials one after the other but were unsuccessful. Ultimately, AGV explantation and reinsertion at another site (in inferotemporal quadrant) was tried, which led to salvaging the eye with well controlled IOP, clear graft, and good visual function (best corrected visual acuity of 6/12p with +12.00/+1.50 × 90◦ ). The purpose of this article was to highlight that despite multiple complications encountered in a single case, a careful sequential approach, good surgical skills, and a never giving up attitude lead to excellent results.