Glaucoma Progression and Role of Glaucoma Surgery in Patients With Boston Keratoprosthesis

Abstract

Glaucoma in B-KPro remains a challenge, despite aggressive attempts to slow down its progression. Patients with glaucoma before B-KPro implantation should be considered for glaucoma surgery before or simultaneously with B-KPro implantation. The high number of eyes with disc pallor suggests that additional mechanisms other than elevated intraocular pressure may play a role in optic neuropathy.

Predictors of Visual Outcomes Following Boston Type 1 Keratoprosthesis Implantation

“…We noted a high prevalence of pre-operative glaucoma than most groups, and the average C:D ratio was also higher than other groups have reported (0.65 vs. 0.46). 13 Based on our clinical observations our practice has changed such that nearly all KPros since June 2013 receive glaucoma tube shunt surgery prior to or concurrent with KPro implantation if no prior intraocular pressure-lowering surgery has been performed. As this is a relatively recent practice, most eyes in the study had not received prophylactic tube shunt surgery.…”

The Boston keratoprosthesis 2014: a step in the evolution of artificial corneas

“…Most patients being evaluated for KPro, in our studies as well as in others, have had glaucoma prior to B-KPro surgery [68]. Subsequently, the glaucoma often worsens, as has been measured by changes in cup/disc ratio and visual fields [24]. In a recent example from the field, 90 % of the patients in a Thai study experienced prompt improvement of vision with B-KPro surgery, compared with preoperatively, but this percentage decreased to 55 % after 6 years.…”

Boston keratoprosthesis type I in the elderly

“…Glaucoma has been described in the literature as a critically important problem in keratoprosthesis recipients 25. In our study population, glaucoma was common preoperatively (50%), and 9.1% of patients developed glaucoma postoperatively.…”