Author(s): Pramila Balasubramaniam1, Vijay Chopra2
Bullous Keratopathy is emerging major cause of treatable blindness nowadays in the era of modern ophthalmology. It represents the terminal stage of severe epithelial oedema occurring usually in diseased eyes. This study has been conducted to enlighten the various aetiological factors, its management both medical and surgical modalities in Government setup. In most cases, aetiology was found to be surgical trauma following cataract surgery with posterior chamber intraocular lens implantation.
MATERIALS AND METHODS
98 patients (100 eyes) who attended the outpatient and inpatient Department of Ophthalmology at Government Vellore Medical College who are diagnosed clinically to have Bullous Keratopathy were enrolled for this study after getting their consent. Detailed history taking, detailed general examination to detect any systemic disease like Diabetes/Hypertension were undertaken. Complete ocular examination, fundus examination was done if it was possible. The IOP was measured. Corneal thickness was measured by Haag-Streit pachymeter. 2% fluorescein staining was carried out to determine the status of corneal epithelium. Relevant laboratory investigations were also done. This is a hospital-based study. The period of our study was from June 2015-June 2016. Ethical committee approval was obtained for conducting the study.
Bullous Keratopathy is a common clinical condition, which occurs in elderly age group, commonly occurring in sixth decade followed by increased incidence in fifth decade well correlated with the age incidence of senile cataract. Study comprised of equal male and female patients of ratio 48:50. Left eye involved in 51.1% cases as more ocular surgeries were done in left eye. About 75% of the cases, the aetiology was due to postsurgical complication. 76 patients, out of 98 cases of Bullous Keratopathy were reported within 1 to 3 years of postoperative period. Most common postsurgical cause was following extracapsular extraction with PCIOL implantation. The bullae were mostly found in centre and superior part of cornea corresponding well with surgical endothelial damage. Bullous Keratopathy associated with raised IOP was seen in 18 out of 98 cases. In these, 15 cases were found to be following ocular surgeries while only 3 cases were due to primary glaucoma. 80 cases were treated with hyperosmotic agents. 24 patients out of 98 cases of Bullous Keratopathy had undergone penetrating keratoplasty. In 19 patients of painful Bullous Keratopathy, anterior stromal puncture was tried. The procedure was repeated in 5 patients. Of the 19 patients, 7 showed the symptomatic relief while 7 patients who had worsening of pain and other symptoms underwent PKP subsequently.
Bullous Keratopathy occurs more commonly in sixth decade followed by fifth decade in this study correlates well with the incidences of senile cataract. Pachymetry was the most useful indicator of endothelial decompensation in this study. Patient who underwent extracapsular extraction with posterior chamber IOL implantation were found to be most susceptible for development of Bullous Keratopathy.