secondary glaucoma

继发性青光眼
  • 文章类型: Journal Article
    探讨二氧化碳(CO2)激光辅助巩膜切除术(CLASS)在中国玻璃体切除术继发青光眼患者中的有效性和安全性。
    这项回顾性研究包括16例玻璃体切除术继发青光眼患者的16只眼,这些患者接受了CLASS并随访了12个月。主要结局指标包括术前和术后眼压,最佳矫正视力(BCVA),抗青光眼药物的数量,术后手术成功率和并发症。
    术后眼压和所有随访时间点使用的抗青光眼药物数量均明显低于术前。手术前后BCVA差异无统计学意义。主要并发症是外周前粘连(PAS)和巩膜储层减少,在掺钕钇铝石榴石(Nd:YAG)激光后进行控制,2例(12.50%)患者行再次手术。12个月的完全成功率和总成功率分别为68.75%和87.50%,分别。
    CLASS是一种安全有效的方法,适用于玻璃体切除术继发青光眼的中国患者。PAS和巩膜储层减少是术后IOP升高的主要原因,Nd:YAG激光小梁微创穿孔可有效降低眼压,增加巩膜池体积。
    UNASSIGNED: To explore the efficiency and safety of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with glaucoma secondary to vitrectomy.
    UNASSIGNED: This retrospective study consisted of 16 eyes from 16 patients with glaucoma secondary to vitrectomy who underwent CLASS and were followed up for 12 months. Main outcome measures included preoperative and postoperative intraocular pressure, best corrected visual acuity (BCVA), number of anti-glaucoma medications, and postoperative surgical success rate and complications.
    UNASSIGNED: The postoperative IOP and number of anti-glaucoma medications used at all follow-up time point were significantly lower than those preoperatively. The difference in BCVA was not significant before and after surgery. The main complicatios were peripheral anterior synechiae (PAS) and scleral reservoir reduction, which were controlled after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, 2 (12.50%) patients underwent re-operation. The complete and total success rates at 12 months were 68.75% and 87.50%, respectively.
    UNASSIGNED: CLASS is a safe and effective procedure for Chinese patients with glaucoma secondary to vitrectomy. PAS and scleral reservoir reduction is a major contributor to postoperative IOP elevation, and trabecular minimally invasive perforation with the Nd:YAG laser is effective in lowering IOP and increasing scleral cistern volume.
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  • 文章类型: Journal Article
    目的:小儿白内障手术后使用糖皮质激素治疗对预防炎症至关重要,但可能会导致继发性青光眼,和下丘脑-垂体-肾上腺轴抑制。我们希望比较小儿白内障手术后高剂量和低剂量糖皮质激素治疗后的青光眼结局。
    方法:这项队列研究包括在10岁之前接受白内障手术的丹麦儿童,接受低剂量或高剂量的术后糖皮质激素治疗。病例识别和标准化数据集的收集是回顾性的,从2010年1月1日至2016年12月31日,以及此后的预期,直到2021年12月31日。高剂量治疗包括0.5-1.0mg结膜下储库地塞米松或甲基强的松龙,随后6-8滴地塞米松1周,每周减少一滴。低剂量治疗包括6滴3天,随后是3滴18天。比较两组持续(>3个月)高眼压或青光眼。
    结果:总体而言,267名儿童(388只眼)被纳入研究。95名儿童(133只眼)接受了大剂量治疗,中位随访时间为89个月(IQR:57.2-107.4)。而173名儿童(255只眼)接受了低剂量治疗,中位随访时间为40.5个月(IQR:22.9-60.4).生存曲线显示,对于轴长≥18mm的儿童,低剂量组的青光眼风险较低。
    结论:低剂量糖皮质激素治疗与眼轴长度≥18mm的儿童青光眼风险降低相关。在眼睛较短的儿童中未观察到相同的效果。大剂量糖皮质激素应限制在接受白内障手术的儿童中。
    OBJECTIVE: Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic-pituitary-adrenal axis suppression. We wish to compare glaucoma outcomes following high-dose and low-dose glucocorticoid treatment after paediatric cataract surgery.
    METHODS: This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low-dose or high-dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High-dose treatment included 0.5-1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6-8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low-dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.
    RESULTS: Overall, 267 children (388 eyes) were included in the study. Ninety-five children (133 eyes) had received high-dose treatment and had a median follow-up time of 89 months (IQR: 57.2-107.4), while 173 children (255 eyes) had received the low-dose treatment and had a median follow-up time of 40.5 months (IQR: 22.9-60.4). Survival curves showed a lower risk of glaucoma in the low-dose group for children with axial lengths ≥18 mm.
    CONCLUSIONS: Low-dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High-dose glucocorticoid should be limited in children undergoing cataract surgery.
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  • 文章类型: Journal Article
    目的:比较先天性风疹综合征(CRS)患儿与非风疹性白内障患儿婴儿期白内障术后继发性青光眼的发生率,并探讨相关危险因素。
    方法:回顾性病例对照研究。
    方法:纳入婴儿期接受白内障手术的CRS患儿和因婴儿白内障而接受白内障手术的年龄匹配的婴儿。
    方法:比较两组的青光眼发生率和生存概率。评估青光眼发展的危险因素。最低随访时间为白内障术后1年。
    结果:该研究包括115名儿童的211只眼。CRS组(病例)101眼(58例儿童),非风疹性白内障组(对照)110眼(57例儿童)。两组之间的手术平均年龄没有显着差异(p=0.96)。在整个14年的研究期间,CRS组为32.7%,对照组为24.5%(p=0.19)。CRS组的平均随访时间为5.8±3.7年,非风疹组的平均随访时间为6.4±3.4年。白内障手术后10年无青光眼生存的累积概率存在显着差异(病例0.53与对照组0.8;log秩p-0.034)。两组在继发性青光眼的发病时间上无显著性差异,降低眼压药物的平均数量和手术治疗青光眼的眼睛数量(p>0.05)。在CRS眼中,微角膜与青光眼的发展有关(风险比2.83,95%置信区间1.44-5.57;p=0.002)。
    结论:与接受婴儿白内障手术的婴儿相比,患有CRS的婴儿进行白内障手术后继发性青光眼的发生率没有显着差异。由于CRS患儿无青光眼生存的十年概率明显较低,建议进行更近距离和更长时间的随访,尤其是在具有高危特征的眼睛中.
    OBJECTIVE: To compare the incidence of secondary glaucoma after cataract surgery performed in infancy in children with congenital rubella syndrome (CRS) and children with non-rubella cataracts and to identify associated risk factors.
    METHODS: Retrospective case control study.
    METHODS: Children with CRS who had undergone cataract surgery in infancy and age matched infants who had undergone cataract surgery for infantile cataracts were included.
    METHODS: Incidence of glaucoma and probability of survival was compared among the two groups. Risk factors for the development of glaucoma were assessed. The minimum follow up was 1 year after cataract surgery.
    RESULTS: The study included 211 eyes of 115 children. The CRS group (cases) had 101 eyes (58 children) and the non-rubella cataract group (controls) included 110 eyes (57 children). There was no significant difference in the mean age at surgery among the two groups (p=0.96). Cumulative incidence of secondary childhood glaucoma for the entire study period of 14 years was 32.7% in the CRS group and 24.5% in the control group (p=0.19). Mean follow-up was 5.8 ± 3.7years for CRS group and 6.4± 3.4years for the non-rubella group. A significant difference in the cumulative probability of glaucoma free survival at 10 years after cataract surgery (cases 0.53 versus controls 0.8; log rank p-0.034) was present. Both groups had no significant difference in the time of onset of secondary glaucoma, average number of intraocular pressure lowering medications and number of eyes with surgical intervention for glaucoma (p>0.05). Microcornea was associated with the development of glaucoma (hazard ratio 2.83, 95% confidence interval 1.44-5.57; p=0.002) in CRS eyes.
    CONCLUSIONS: There was no significant difference in the incidence of secondary glaucoma after cataract surgery performed in infants with CRS compared to infants who had undergone surgery for infantile cataracts. Since the ten year probability of glaucoma free survival was significantly less in children with CRS, a closer and longer follow up is recommended especially in eyes with at-risk features.
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  • 文章类型: Case Reports
    目的:虹膜角膜内皮(ICE)综合征是一种罕见的疾病,其特征是内皮的异常增殖和结构改变,虹膜角膜角度的闭塞,和虹膜的异常。这些变化的后果是继发性青光眼和角膜代偿失调。病因尚不清楚,这种综合征更常见于中年妇女。
    方法:在本文中,我们提供了两个不同的病例研究,这些病例研究的年轻患者被诊断为有并发症的ICE综合征。第一个病例报告是关于一名年轻妇女,她成功地手术治疗了青光眼和角膜水肿。另一方面,第二份报告介绍了一例29岁患者的复杂病例,尽管反复进行干预,但治疗仍未成功.
    结论:本文强调了ICE综合征的复杂性,其治疗的难度和早期诊断的重要性。
    Iridocorneal endothelial (ICE) syndrome is a rare disease characterized by abnormal proliferation and structural changes of the endothelium, obliteration of the iridocorneal angle, and anomalies of the iris. The consequence of these changes is secondary glaucoma and corneal decompensation. The etiology is unclear, and the syndrome more commonly affects middle-aged women.
    In this article we present two different case studies of young patients diagnosed with ICE syndrome with complications. The first case report is about a young woman in whom surgical treatment of glaucoma and corneal edema was successful. On the other hand, the second report presents a complicated case of a 29-year-old patient whose treatment was not successful despite repeated interventions.
    This text highlights the complexity of ICE syndrome, the difficulty of its therapy and the importance of early diagnosis.
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  • 文章类型: Case Reports
    我们报告了一例成功的氩激光粘连溶解术,作为年轻的类固醇引起的高眼压患者小梁切除术后外周前粘连释放的非侵入性替代方法。由于长期使用类固醇治疗,类固醇诱导的高眼压是春季角膜结膜炎的已知并发症。在屈光条件下,增强小梁切除术成为这些患者的首选手术。在这篇文章中,我们报道了用氩激光和恢复水流成功治疗虹膜组织堵塞内口。
    We report a case of successful argon laser synechiolysis as a non-invasive alternative for peripheral anterior synechiae release after trabeculectomy in a young patient with steroid-induced ocular hypertension. Steroid-induced ocular hypertension is a known complication of vernal keratoconjunctivitis due to prolonged treatment with steroids. In refractive conditions, augmented trabeculectomy becomes the surgery of choice in these patients. In this article, we report successful treatment of iris tissue plugging the internal ostium with an argon laser and reinstatement of aqueous flow.
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  • 文章类型: Historical Article
    在1854年的第一期Graefe档案中,AlbrechtvonGraefe写了关于青光眼的文章。青光眼来自希腊语“glaukos,\"闪闪发光,这是荷马在公元前800年左右首次使用的。从那以后,青光眼和青光眼有许多不同的含义。术语失明,在难以理解的情况下,白内障和青光眼可互换使用,并一起扭曲。超过2500年的青光眼理论被1851年的检眼镜的发现所颠覆。关于眼压升高的第一批报道出现在17世纪中叶,但是这种升高的压力花了200多年才被眼科界接受。1861年单纯性青光眼的发现是向前迈出的重要一步。在1850年之前,医生对青光眼了解多少,为什么花了这么长时间将青光眼分类为不同类别?为什么我们仍然不知道原发性开角型青光眼的原因是什么?在进行历史概述之后,我将尝试回答其中一些问题。
    In the first issue of Graefe\'s Archive from 1854, Albrecht von Graefe wrote about glaucoma. Glaucoma comes from the Greek word \"glaukos,\" gleaming, which was first used by Homer around 800 BCE. Since then, glaukos and glaucoma have taken on many different meanings. The terms blindness, cataract and glaucoma were used interchangeably and twisted together in incomprehensible contexts. Over 2500 years of glaucoma theories were upset by the discovery of the ophthalmoscope in 1851. The first reports of increased intraocular pressure appeared in the mid-seventeenth century, but it took over 200 years for this elevated pressure to be accepted by the ophthalmological community. The discovery of glaucoma simplex in 1861 was an important step forward. What did doctors know about glaucoma before 1850 and why did it take so long to classify glaucoma in its various categories? And why is it that we still do not know what the cause is for primary open angle glaucoma? I will try to answer some of these questions after a historical overview.
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  • 文章类型: Journal Article
    目的:探讨儿童白内障手术后的视觉发育和长期并发症。
    方法:这项横断面研究包括一个患有Marner遗传性白内障的家庭患者,他们在18岁之前接受了白内障手术。该研究从2022年1月1日至2022年12月31日进行。患者为他们的医疗档案做出了贡献,并参加了更新的眼科检查。
    结果:我们包括52例患者(101眼,34名女性)。白内障手术的中位年龄为7岁(IQR:5-10),检查年龄为40岁(IQR:21-54)。47.5%的患者进行了原发性和继发性人工晶状体植入术(25例患者,48眼)和16.8%(10例,17只眼睛)。77%(78眼)的视力≤0.3logMAR,8%(8只眼睛)的logMAR<0.5。17%存在青光眼(9例患者,12只眼睛),6%的高眼压(3例,4只眼睛),和10%(5名患者,5只眼)先前有视网膜脱离。62%(63只眼)发现轻度视野损失(2<平均缺损(MD)≤6dB),24%(24只眼)发现中度至晚期视野损失(MD>6dB)。35名病人(67%)持有驾驶执照,三人因视觉功能低下而不允许开车。所有患者均被雇用。
    结论:儿童白内障手术后,许多患者达到正常视力,但轻度视野丧失是常见的。由于青光眼的高风险,长期随访很重要。
    OBJECTIVE: To investigate visual development and long-term complications after cataract surgery in childhood.
    METHODS: This cross-sectional study included patients from a family with Marner\'s hereditary cataracts who had cataract surgery before 18 years of age. The study was conducted from 1 January 2022 until 31 December 2022. The patients contributed to their medical files and participated in an updated ophthalmologic examination.
    RESULTS: We included 52 patients (101 eyes, 34 females). The median age at cataract surgery was 7 years (IQR: 5-10) and the age at examination was 40 years (IQR: 21-54). Primary and secondary intraocular lens implantation had been performed in 47.5% (25 patients, 48 eyes) and 16.8% (10 patients, 17 eyes). Visual acuity was ≤0.3 logMAR in 77% (78 eyes), and <0.5 logMAR in 8% (8 eyes). Glaucoma was present in 17% (9 patients, 12 eyes), ocular hypertension in 6% (3 patients, 4 eyes), and 10% (5 patients, 5 eyes) had prior retinal detachment. Mild visual field loss (2 < mean defect (MD) ≤ 6 dB) was found in 62% (63 eyes) and moderate to advanced visual field loss (MD > 6 dB) in 24% (24 eyes). Thirty-five patients (67%) held a driver\'s licence, and three were not allowed to drive due to low visual function. All patients were employed.
    CONCLUSIONS: After cataract surgery in childhood, many patients achieve normal visual acuity, but mild visual field loss is common. Long-term follow-up is important due to the high risk of glaucoma.
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  • 文章类型: Journal Article
    描述玻璃体视网膜手术(VR手术)后瞳孔阻滞型青光眼(PBG)的临床表现和治疗结果。
    6941例患者的回顾性观察研究,2015年1月至2019年12月在印度南部的三级眼科护理中心接受了VR手术。在他们当中,对61例发生PBG的患者的临床资料进行统计分析.
    平均(SD)年龄为53.90(13.4)岁,PBG的发生率为0.87%。VR手术后PBG发作的中位时间(IQR)为3.33(1.1-6.6)个月,大多数为假晶状体(75%)。50例(82%)患者单独使用Nd:YAG激光周边虹膜切开术(LPI)解决PBG,而11名(18%)患者需要额外的干预措施,如手术虹膜切除术,小梁切除术或二极管激光睫状体光凝术(CPC)作为独立程序或与硅油去除(SOR)结合使用。PBG发作时的平均(SD)眼压为41.61(14.5)mmHg,LPI后急剧下降至24.28(14.9)mmHg,在6个月后进一步显着下降至20.34(13.9)mmHg。
    VR手术后继发性PBG的发生率为0.87%,我们观察到糖尿病,白内障联合VR手术,使用1000csSO内填充剂,术中激光和多次VR手术干预是常见的关联。VR程序后,大多数PBG患者通过LPI和医疗管理解决。少数人(18%)需要额外的激光或手术干预来控制IOP。
    UNASSIGNED: To describe the clinical presentation and treatment outcomes of pupillary block glaucoma (PBG) following vitreoretinal surgery (VR surgery).
    UNASSIGNED: Retrospective observational study of 6941 patients, who underwent VR surgery at a tertiary eye care centre in South India between January 2015 and December 2019. Amongst them, clinical data of 61 patients who developed PBG were taken for statistical analysis.
    UNASSIGNED: Mean (SD) age was 53.90 (13.4) years and the incidence of PBG was .87%. Median (IQR) time of onset of PBG following VR surgery was 3.33 (1.1-6.6) months and majority were pseudophakic (75%). PBG resolved with Nd:YAG laser peripheral iridotomy (LPI) alone in 50 (82%) patients, whereas 11(18%) patients required additional interventions like surgical iridectomy, trabeculectomy or diode laser cyclophotocoagulation (CPC) either as a stand-alone procedure or in combination with silicone oil removal (SOR). Mean (SD) intraocular pressure at the onset of PBG was 41.61 (14.5) mmHg, which reduced drastically following LPI to 24.28 (14.9) mmHg which further dropped significantly at 6 months follow up to 20.34 (13.9) mmHg.
    UNASSIGNED: Incidence of secondary PBG after VR surgery was .87%, and we observed diabetes mellitus, combined cataract and VR surgery, use of 1000cs SO endotamponade, intraoperative endolaser and multiple VR surgical interventions as common associations. Majority of the patients with PBG after VR procedures resolved with LPI and medical management. Few individuals (18%) required additional laser or surgical intervention for IOP control.
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  • 文章类型: Journal Article
    目的:评价经半平面入路内镜下睫状体光凝(ECP)治疗难治性青光眼患者的长期疗效设计:单中心,回顾性,纵向,队列研究。
    方法:本研究招募了在北京同仁市眼科中心连续就诊并随访至少5年的ECP患者,中国从2013年1月到2017年12月。所有患者都接受了完整的眼科检查。治疗成功定义为6mmHg≤IOP≤21mmHg,有或没有抗青光眼药物。
    结果:共纳入105名患者的121只眼,包括51名儿童和54名成人。平均随访时间为7.2±1.3年。最常见的青光眼诊断是继发性青光眼(74眼,61.1%)和原发性先天性青光眼(19眼15.7%)。第一次ECP的平均程度为259度。术前33.3±9.0mmHg至术后20.5±7.5mmHg的眼压总体下降38.3%,有统计学意义(P<0.001)。1次及以上ECP手术成功率为65.3%。在适应性爱之后,先前的TCP手术次数和ECP程度,ECP失败与儿童(与成人相比,P=0.028;OR=2.549)和术前IOP较高(P=0.001;OR=1.084)相关.
    结论:ECP是降低难治性青光眼眼压的有效方法,特别是在也是玻璃体视网膜干预的候选人的患者中。因此,青光眼和视网膜专家之间的合作方法对于设计青光眼治疗的最佳管理策略至关重要。
    OBJECTIVE: To evaluate the long-term efficacy of endoscopic cyclophotocoagulation (ECP) via a pars plana approach in a large cohort of refractory glaucoma patients DESIGN: Single-center, retrospective, longitudinal, cohort study.
    METHODS: This study recruited patients who underwent ECP and consecutively visited and were followed up for at least 5 years at Beijing Tongren Eye Center, China from January 2013 to December 2017. All patients underwent a complete ophthalmic examination. Treatment success was defined as 6 mmHg ≤ IOP ≤ 21 mmHg with or without anti-glaucoma medications.
    RESULTS: A total of 121 eyes of 105 patients including 51 children and 54 adults were enrolled. The mean follow-up was 7.2 ± 1.3 years. The most common glaucoma diagnoses were secondary glaucoma (74 eyes, 61.1 %) and primary congenital glaucoma (19 eyes 15.7 %). The mean extent of the first ECP was 259 degrees. There was an overall decrease in IOP of 38.3 % from 33.3 ± 9.0 mmHg preoperatively to 20.5 ± 7.5 mmHg after surgery, which was statistically significant (P < 0.001). The success rate after 1 or more ECP surgery was 65.3 %. After adjusting for sex, number of prior TCP surgeries and the extent of ECP degree, the failure of ECP was associated with being children (as compared with adults; P = 0.028; OR = 2.549) and higher preoperative IOP (P = 0.001; OR = 1.084).
    CONCLUSIONS: ECP is an effective procedure for lowing IOP in refractory glaucoma, particularly in patients who are also candidates for vitreoretinal interventions. Hence, a collaborative approach between glaucoma and retinal specialists is of utmost importance in devising an optimal management strategy for glaucoma treatment.
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  • 文章类型: Journal Article
    青光眼是导致不可逆性视力丧失的主要原因之一。它通常是无症状的,直到它达到晚期,这会对患者的日常生活产生重大影响。本文描述了一名50岁女性患者的病例,该患者表现为急性眼痛,畏光,和视力丧失在她的右眼(RE)。患者的病史包括先天性白内障,外科无晶状体,眼球震颤,斜视,弱视,和继发性青光眼。眼科检查显示BCVARE-手部运动,左眼(LE)-0.08,RE的眼内压(IOP)为30mmHg,LE的眼内压为16mmHg。RE的生物显微镜检查显示角膜移植物,上皮和内皮水肿,内皮沉淀物,角膜新生血管形成,无晶状体,和艾哈迈德瓣膜超瞬时。尽管最大的局部和全身治疗,Ahmed阀门,小梁切除术,右眼继发性青光眼仍然难治。进行Ahmed瓣膜的再植入。这导致了良好的结果,具有增加的视敏度和控制的眼内压。无晶状体的组合,穿透性角膜移植术,继发性青光眼对任何外科医生来说都是一个挑战。重要的是要仔细评估每位患者的围手术期风险和可能的并发症。特别是如果存在相关病理。
    Glaucoma is one of the world\'s leading causes of irreversible vision loss. It is often asymptomatic until it reaches an advanced stage, which can have a significant impact on patients\' daily lives. This paper describes the case of a 50-year-old female patient who presented with acute onset of ocular pain, photophobia, and loss of visual acuity in her right eye (RE). The patient\'s medical history includes congenital cataracts, surgical aphakia, nystagmus, strabismus, amblyopia, and secondary glaucoma. Ophthalmological examination showed BCVA RE-hand movement, left eye (LE)-0.08 with an intraocular pressure (IOP) of 30 mmHg in RE and 16 mmHg in LE. Biomicroscopic examination of RE showed corneal graft, epithelial and endothelial edema, endothelial precipitates, corneal neovascularization, aphakia, and Ahmed valve superotemporally. Despite maximal topical and systemic treatment, Ahmed valve, and trabeculectomy, secondary glaucoma in the right eye remained refractory. Reimplantation of an Ahmed valve was performed. This resulted in a favorable outcome with increased visual acuity and controlled intraocular pressure. The combination of aphakia, penetrating keratoplasty, and secondary glaucoma is a challenge for any surgeon. It is important that both the perioperative risks and the possible complications are carefully assessed in each patient, especially if associated pathology is present.
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