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Joseph Panarelli, Anne Ko, Julian P. Garcia, Paul A. Sidoti, Michael R. Banitt; Angle Closure By Anterior Segment Optical Coherence Tomography After Boston Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):343.
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© ARVO (1962-2015); The Authors (2016-present)
To qualitatively assess the anterior chamber angle using anterior segment optical coherence tomography (AS-OCT) to determine how frequently angle closure develops after Boston Keratoprosthesis (K-Pro) implantation.
All imaging was performed with the AS-OCT (AC cornea OCT prototype; Ophthalmic Technologies, Toronto, Ontario, Canada). Imaging was performed pre-operatively, 1, 6, 12, and 18 months post-operatively. Horizontal scans were obtained for all patients. The three and nine o’clock positions were examined and compared across all time points. For each image, the scleral spur was identified and the angle was judged to be open or closed.
Ten patients were followed for a mean of 21.5 ± 15.7 months. Six of the ten patients had preoperative AS-OCTs, three had pre-operative UBMs, and one patient’s angle structure was evaluated by clinical exam. Seven of the ten eyes had open angles at the 3 and 9 o’clock positions preoperatively; one eye demonstrated partial angle closure while two eyes had complete angle closure. Of the seven eyes with initially open-angles, three remained open post-operatively. The four eyes that developed angle closure post-operatively did so within 1 to 4 months. Repeat imaging confirmed progression of the initial findings of synechial angle closure in two of the four patients. Of the four patients that developed angle closure, three were thought to have IOP within the normal range by finger tension and all had functioning glaucoma drainage devices (GDD). The fourth patient did not undergo GDD placement prior to K-Pro but has shown progressive cupping. Irido-backplate touch was noted in four patients with angle compromise. Only one of these patients had evidence of angle closure pre-operatively.
In summary, 4 of 10 patients developed synechial angle closure within four months of K-Pro placement as documented by AS-OCT. Adhesion of the iris to the backplate may play a significant role in the development of angle-closure glaucoma after K-Pro surgery. Comprehensive imaging of the angle with horizontal, vertical, and oblique scans may provide valuable information with which to manage keratoprosthesis recipients.
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