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Julia C. Talajic, Sebastien Gagne, Younes Agoumi, Mona Harissi-Dagher; Long-term Results Regarding the Impact of Glaucoma on Vision following Boston Keratoprosthesis Type 1 Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1635.
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© ARVO (1962-2015); The Authors (2016-present)
To determine glaucoma prevalence, progression, treatment, and impact on vision in patients having undergone implantation of Boston Keratoprosthesis type 1 (KPro).
This chart review included 38 consecutive eyes in 38 patients with KPro implantation since 2008. Information gathered included: corneal diagnosis, pre- and post-operative visual acuity (VA), intraocular pressure (IOP), visual fields (VF), optic nerve status, glaucoma treatment, glaucoma-related complications, and other pathologies limiting VA and VF.
Mean follow-up was 15.8 months. Pre-KPro, 74% of patients were known to have glaucoma: 37% had had previous glaucoma surgery and 42% were on glaucoma medication. Post-KPro, 89% of patients were deemed to have glaucoma; 66% of patients had advanced glaucoma, meaning they either had a cup to disc ratio above 0.9 or visual field loss within 10 degrees of fixation. 68% of patients' glaucoma medication was increased postoperatively, and 18% of patients were deemed to have definite progression (VF progression and/or need for surgery). 37% of patients had a C/D ratio exceeding 0.85. 5 patients needed surgery for uncontrolled IOP on maximal medication. 2 underwent Ahmed tube implantation followed by pars plana vitrectomy (PPV) combined with endocyclophotocoagulation; the third also had an Ahmed tube implanted, then developed corneal melt requiring a tectonic corneal graft. Another patient underwent transcleral cyclophotocoagulation. The fifth patient patient had a PPV for vitreous obstruction of a pre-existing shunt, then developed hyperfiltration and choroidal detachment (CD). Two other patients experienced CD (one had a pre-existing tube shunt, the other was on two glaucoma drops). 14 patients’ VA was limited by glaucoma (37%), 12 of which had a VA of 20/200 or worse. Five patients had a dramatic improvement in VA, then progressed to end-stage glaucoma (with loss of fixation), whereas the other 7 patients already had poor vision post-operatively due to prior advanced glaucoma damage. 66% of patients had VF limited by glaucoma, with an average MD of -20.26 decibels.
Longer term follow-up of KPro patients reveals a greater number of patients with glaucoma progression and advanced glaucoma than previously reported. It is likely that clinicians underestimate IOP with digital palpation. Serial VFs are paramount in the detection of glaucoma progression in KPro patients and are often the first indication of progression. A very low threshold should be used to treat suspicion of even slightly elevated IOP.
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