A Clinical Case of the Development of Unilateral Pseudoexfoliative Glaucoma in a Young Patient after Bilateral Penetrating Keratoplasty
https://doi.org/10.18008/1816-5095-2025-1-184-190
Abstract
The article describes a clinical case of the unilateral process development of Pseudoexfoliative glaucoma (PEG), in a young man, 38 years old, who had previously undergone a penetrating keratoplasty of both eyes. This case is interesting for the early development of the glaucoma process, the severity of manifestations of pseudoexfoliation syndrome at an atypical age.
Objective: present the features of the clinical course, evaluate the atypicality of the onset and course of the glaucomatous process, the effectiveness of medication, treatment of POAG in the context of a corneal transplant, which leads to tonometric errors. Clinical case of 38-yearold patient of Caucasian origin (Armenian), who underwent sequential penetrating keratoplasty of both eyes in the city of Yerevan in 2000 and 2007. At the time of the examination, open-angle developed decompensated (II C) glaucoma and pseudoexfoliation syndrome of the right eye were detected, confirmed by available research methods. Local drug therapy was prescribed: FC brimonidine 0.2 % + timolol 0.5 % and brinzolamide 1 %, 1 drop 2 times a day in the right eye, as a result of which IOP was compensated.
About the Authors
A. V. MalyshevRussian Federation
Malyshev Alexey V., MD, Professor, Head of the Ophthalmology Department
Pervomaiskaya str., 192, Maykop, 385000
1 May str., 167, Krasnodar, 350086
A. S. Apostolova
Russian Federation
Apostolova Anastasia S., PhD, ophthalmologist, glaucoma specialist, аssistant Professor
Pervomaiskaya str., 192, Maykop, 385000
Krasnykh Partizan str., 18, Krasnodar, 350047
A. A. Sergienko
Russian Federation
Sergienko Aleksey A., PhD, ophthalmologist, Assistant Professor
Pervomaiskaya str., 192, Maykop, 385000
Krasnykh Partizan str., 18, Krasnodar, 350047
A. F. Teshev
Russian Federation
Teshev Adam F., Head of the Ophthalmology Department, Assistant Professor
Pervomaiskaya str., 192, Maykop, 385000
Zhukovsky str., 4, Maykop, 385000
G. Yu. Karapetov
Russian Federation
Karapetov Garry Yu., PhD, ophthalmologist, Assistant Professor
Pervomaiskaya str., 192, Maykop, 385000
May str., 167, Krasnodar, 350086
M. K. Ashkhamakhova
Russian Federation
Ashkhamakhova Marina K., ophthalmologist, assistant
Pervomaiskaya str., 192, Maykop, 385000
Zhukovsky str., 4, Maykop, 385000
B. N. Hatsukova
Russian Federation
Hatsukova Bella N., ophthalmologist, assistant
Pervomaiskaya str., 192, Maykop, 385000
Zhukovsky str., 4, Maykop, 385000
References
1. Zemba M, Stamate AC. Glaucoma after penetrating keratoplasty. Rom J Ophthalmol. 2017 Jul-Sep;61(3):159–165. doi: 10.22336/rjo.2017.30.
2. Nguyen NX, Langenbucher A, Seitz B, Küchle M. Häufigkeit und Risikofaktoren der Augeninnendruckerhöhung nach perforierender Keratoplastik. Frequency and risk factors of intraocular pressure increase after penetrating keratoplasty. Klin Monbl Augenheilkd. 2000 Aug;217(2):77–81. German. doi: 10.1055/s-2000-10388.
3. Ida Y, Shimizu T, Kuroki T, Mizuki Y, Takeda M, Mizuki N, Yamagami S, Hayashi T. Risk factors for intraocular pressure elevation following Descemet membrane endothelial keratoplasty in Asian patients. Graefes Arch Clin Exp Ophthalmol. 2023 Mar;261(3):749–760. doi: 10.1007/s00417-022-05835-y.
4. Nazarali S, Damji F, Damji KF. What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? Br J Ophthalmol. 2018 Oct;102(10):1342–1350. doi: 10.1136/bjophthalmol-2017-311321.
5. Zheng X, Shiraishi A, Okuma S, Mizoue S, Goto T, Kawasaki S, Uno T, Miyoshi T, Ruggeri A, Ohashi Y. In vivo confocal microscopic evidence of keratopathy in patients with pseudoexfoliation syndrome. Invest Ophthalmol Vis Sci. 2011 Mar 28;52(3):1755–1761. doi: 10.1167/iovs.10-6098.
6. Musch DC, Shimizu T, Niziol LM, Gillespie BW, Cashwell LF, Lichter PR. Clinical characteristics of newly diagnosed primary, pigmentary and pseudoexfoliative openangle glaucoma in the Collaborative Initial Glaucoma Treatment Study. Br J Ophthalmol. 2012 Sep;96(9):1180–1184. doi: 10.1136/bjophthalmol-2012-301820.
7. Milioti G, Löw U, Gatzioufas Z, Ninios K, Schirra F, Seitz B. Frühe Manifestation eines Pseudoexfoliations-Syndroms nach Hornhauttransplantation [Early manifestation of a pseudoexfoliation syndrom after a cornea transplantation]. Klin Monbl Augenheilkd. 2011 Mar;228(3):249–251. German. doi: 10.1055/s-0029-1245164.
8. Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol. 2001 Jan-Feb;45(4):265–315. doi: 10.1016/s0039-6257(00)00196-x.
9. Mitchell P, Wang JJ, Hourihan F. The relationship between glaucoma and pseudoexfoliation: the Blue Mountains Eye Study. Arch Ophthalmol. 1999 Oct;117(10):1319–1324. doi: 10.1001/archopht.117.10.1319.
10. Nazarali S, Damji F, Damji KF. What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? Br J Ophthalmol. 2018 Oct;102(10):1342–1350. doi: 10.1136/bjophthalmol-2017-311321.
11. Rochepeau C, El Ameen B, Burillon C. Unilateral Pseudoexfoliation Deposits on an Intraocular Lens. JAMA Ophthalmol. 2021 Mar 1;139(3):e206856. doi: 10.1001/jamaophthalmol.2020.6856.
12. Bhattacharjee H, Mishra S, Garg M. Pseudoexfoliative Deposits on an Intraocular Lens. JAMA Ophthalmol. 2023 Jun 1;141(6):e230407. doi: 10.1001/jamaophthalmol.2023.0407.
13. Kumaran N, Girgis R. Pseudoexfoliative deposits on an intraocular lens implant. Eye (Lond). 2011 Oct;25(10):1378–1379. doi: 10.1038/eye.2011.159.
14. Niederer RL, Perumal D, Sherwin T, McGhee CN. Corneal innervation and cellular changes after corneal transplantation: an in vivo confocal microscopy study. Invest Ophthalmol Vis Sci. 2007 Feb;48(2):621–626. doi: 10.1167/iovs.06-0538.
15. Salvetat ML, Zeppieri M, Miani F, Tosoni C, Parisi L, Brusini P. Comparison of iCare tonometer and Goldmann applanation tonometry in normal corneas and in eyes with automated lamellar and penetrating keratoplasty. Eye (Lond). 2011 May;25(5):642–650. doi: 10.1038/eye.2011.60.
16. Maier AK, Gundlach E, Pahlitzsch M, Gonnermann J, Corkhill C, Bertelmann E, Joussen AM, Klamann MK, Torun N. Intraocular Pressure Measurements After Descemet Membrane Endothelial Keratoplasty. J Glaucoma. 2017 Mar;26(3):258–265. doi: 10.1097/IJG.0000000000000593.
17. Tekin K, Inanc M, Elgin U. Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives. Clin Ophthalmol. 2019 Mar 1;13:453–464. doi: 10.2147/OPTH.S181444.
18. Kurysheva N.I., Shatalova E.O., Apostolova A.S. Efficacy of Selective Laser Trabeculoplasty in different types of glaucoma. Glaucoma news. 2017;1(41):63–66 (In Russ.).
19. Kurysheva N.I., Apostolova A.S., Shatalova E.O., Semenistaya A.A. Long-term results of selective laser trabeculoplasty in pseudoexfoliation glaucoma. National journal Glaucoma. 2014;13(1):13–20 (In Russ.).
20. Kurysheva N.I., Ryzhkov P.K., Topol’nik E.V., Kapkova S.G. Condition of corneal endothelium after selective laser trabeculoplasty. National journal Glaucoma. 2012;2:38–43 (In Russ.).
Review
For citations:
Malyshev A.V., Apostolova A.S., Sergienko A.A., Teshev A.F., Karapetov G.Yu., Ashkhamakhova M.K., Hatsukova B.N. A Clinical Case of the Development of Unilateral Pseudoexfoliative Glaucoma in a Young Patient after Bilateral Penetrating Keratoplasty. Ophthalmology in Russia. 2025;22(1):184-190. (In Russ.) https://doi.org/10.18008/1816-5095-2025-1-184-190