EnVision Summit 2025: Glaucoma with co-existing ocular co-morbidities
At the EnVision Summit 2025 in San Juan, Puerto Rico, Poonam Misra, MD, and Alcina Lidder, MD, gave advice on managing glaucoma in patients with other ocular co-morbidities such as myopia and those who have undergone corneal transplantation.
Poonam Misra, an assistant professor at Manhattan Eye Ear and Throat Hospital, discussed the management of corneal transplantation in patients with glaucoma. She emphasized the importance of understanding the patient's pre-existing conditions, including angle anatomy and degree of glaucoma, to effectively manage increases in intraocular pressure after transplantation. Misra explained that different types of transplants can have varying responses in terms of intraocular pressure elevation, and monitoring pressure is crucial due to the challenges posed by corneal shape and thickness. Misra outlined the treatment approach, starting with SLT and medical therapy, followed by milder glaucoma surgeries like canaloplasty or goniotomy, depending on the optic nerve health. In severe cases, she noted that more aggressive interventions such as trabeculectomy or tube shunt surgery may be necessary, with tube shunt surgery often preferred to avoid the corneal graft.