Differential Diagnosis - Pacific University

5/29/2012
Other Ocular Findings:
◦ Cells/flare in anterior
chamber
◦ Subluxed IOL
◦ Shunt tube w/ current or
previous endothelial touch
◦ Elevated IOP
◦ Cystoid macular edema (CME)
has been associated with PBK,
especially in patients with an
anterior chamber IOL
As is the case with most conditions,
treatment depends on the severity of the
disease in each patient.
Mild cases may respond to medical therapy,
while moderate to severe cases often require
surgery.
Mild
◦ Edema
• Muro 128 (NaCl 5%) gtts QID
• Muro 128 (NaCl 5%) ung QHS
◦ Elevated IOP
• Antiglacuoma medications
• Avoid prostaglandin analogues to reduce risk of CME
◦ CME
• Treat as with other cases of CME
Surgical procedures are dependent on the
severity of the patient’s condition as well as
their visual potential.
Penetrating Keratoplasty Diagram
If a patient is a cataract surgery candidate
and has Fuch’s, measures must be taken to
protect the cornea.
For healthy corneas with guttata, viscoelastic
should be used
◦ Most surgeons use the soft-shell technique
• Combines cohesive and dispersive viscoelastic
◦ Viscoelastic protects the endothelium from the
energy released during phacoemulsification as well
as the trauma that is incurred during surgery
Corneas with stromal edema take special care
and consideration when cataract surgery is to
be performed.
If CCT is greater than 640um, a “Triple”
procedure may be considered
◦ Triple= Phacoemulsification+IOL implantation+cornea transplant
If the patient elects for CE without a
transplant, they MUST be educated that they
will likely need one in the future.
Coursebook Page 5 of 139
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