Dellen-like keratopathy associated with glaucoma drainage devices

Abstract

To report the first case of dellen-like keratopathy with superior corneal thinning associated with implantation of glaucoma drainage devices. A 70-year-old male with a history of primary open angle glaucoma and dry eye disease underwent placement of glaucoma drainage devices with antimetabolite application in both eyes. Prior to placement, minimal refractive error was noted on manifest refraction. Several years later, the patient was referred for decreased vision and corneal irregularity. Examination showed pathologic corneal curvature, superior corneal thinning, and epithelial demarcation lines immediately anterior to the glaucoma drainage devices in both eyes. The epithelium remained intact with no evidence of limbal stem cell deficiency. Manifest refraction revealed a large change in both eyes. Topography was used to confirm the presence of irregular corneal curvature anterior to the glaucoma drainage devices. Dellen-like keratopathy with superior thinning is a rare sequela after implantation of a glaucoma drainage device that must be considered in elderly patients who undergo glaucoma surgery. It is likely related to a combination of tear film alteration related to previously large anterior blebs, antimetabolite application, and aqueous humor flow patterns around the drainage devices. Treatment should focus on lubrication.

Surgical Management for Refractory Bleb Dysesthesia

“…Corneal Dellen is an uncommon complication of extensive blebs [2,20] and its satisfactory treatment is extremely important to prevent corneal ulceration and subsequent potential perforation [2]. If lubrication is ineffective, a contact lens (conventional or bandage) can be used [21] but its adequate fitting is often challenging in these cases due to bleb-related conjunctival irregularity [22], so definitive reductive surgery should be taken into account.…”