Purchase this article with an account.
Andrea Carolina Arteaga, Lindsay Machen, Ahmad A Aref, Maria Soledad Cortina, Thasarat S Vajaranant; DE NOVO GLAUCOMA IN BOSTON KERATOPROSTHESIS TYPE 1: PATIENT CHARACTERISTICS AND OUTCOMES. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5694. doi: https://doi.org/.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Glaucoma development or progression of pre-existing glaucoma is the most common blinding complication in patients implanted with Boston type 1 keratoprosthesis (KPro). In eyes with previous diagnosis of glaucoma, a combined surgery with glaucoma drainage device (GDD) implantation at the time of the KPro is recommended. For patients without glaucoma, it is generally accepted that the risk of developing glaucoma after KPro implantation is high however there is not enough evidence to support placement of GDD at the time of KPro implantation. The purpose of this study is to report the frequency of the novo glaucoma that required medical and/or surgical treatment and their outcomes.
We performed a retrospective chart review of 132 patients that received KPro implantation at the Illinois Eye and Ear Infirmary during 2006 to 2015. De novo glaucoma was defined as absence of pre-existing glaucoma plus one of the following criteria: 1) increase of intraocular pressure (IOP); 2) initiation of topical medications; 3) need for glaucoma laser procedure; or 4) need for glaucoma drainage device to control intraocular pressure. Patients with pre-existing glaucoma or that lacked one-year follow-up were excluded.
The final analysis included 39 eyes (41.5%) without pre-existing glaucoma. The incidence of the novo glaucoma was 28.2% (11/39). The mean time from KPro implantation to the development of glaucoma was 15.63 months (SD ± 17.50, range from 2 to 60 months). Mean IOP was 16.08 mmHg (SD± 7.67) preoperative and 17.37 mmHg (SD± 6.03) at 1-year follow-up. Of those who developed glaucoma, 36.4% of patients were treated with topical medications alone, 36.4% required subsequent GDD implant and 18.2% glaucoma laser treatment.
A significant number of patients without pre-existing glaucoma will develop de novo glaucoma after KPro implantation. Glaucoma in these patients if difficult to manage with medical treatment alone, and more than 50% will require surgical intervention to control the intraocular pressure. Risk of vision loss from de novo glaucoma should be weighed against risks of combined surgery at the time of KPro implantation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only