Technique of Combined Glaucoma Tube Shunt and Keratoprosthesis Implantation

Law, Simon K.; Huang, Jenny; Nassiri, Nariman; Moghimi, Sasan; Nilforushan, Naveed; Azarbod, Parham; Moossai, Jonathan; Kim, Michelle; Aldave, Anthony J.

doi:10.1097/ijg.0b013e31829d9c00

Cited by 15 publications

(5 citation statements)

References 18 publications

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“…KPro implantation was performed in a standard technique as described in the literature. 20,21 The decision for the type of glaucoma procedure was based on the presence of pre-existing glaucoma, severity of glaucoma, previous surgeries, target IOP, and surgeon preference. GDD implantation was usually performed for patients with pre-existing glaucoma, and endocyclophotocoagulation, transscleral cyclophotocoagulation, or ultrasound ciliary plasty was considered for other patients as described below.…”

Section: Surgical Technique and Postoperative Carementioning

confidence: 99%

Intermediate-term Visual Outcomes and Complications of Type 1 Boston Keratoprosthesis With and Without Glaucoma Surgery

AlHilali

Martínez-Osorio

AlObaida

et al. 2022

Cornea

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Purpose: Glaucoma is a cause of comorbidity in patients receiving the Boston keratoprosthesis (KPro). The aim of this study was to report the outcomes of the Boston KPro with or without glaucoma surgery.Methods: This was a retrospective single-center cohort study.Patients who underwent Boston KPro from March 2009 to February 2019 were included. One eye per patient (the first surgery) was included in this study. Patients were classified into 2 groups: KPro only (group 1) and KPro with any form of glaucoma procedure (group 2). Main outcome measures were Best-corrected visual acuity (BCVA), functional success (BCVA 20/200 or better), anatomical success (retention of KPro at the last follow-up), and complications.Results: Seventy-one eyes were included: 27 eyes (38%) in group 1 and 44 (62%) in group 2. There was no statistically significant difference in BCVA between groups 1 and 2 at each time point. Of the eyes in group 1, 11% lost light perception vision and 4.5% in group 2 (P = 0.293). There was no difference in anatomical success with 70% in group 1 and 77% in group 2 (P = 0.703) at the last follow-up, with a median failure time of 18 months. The functional success was 48% for group 1 and 50% for group 2 (P = 0.541).Conclusions: Eyes undergoing KPro with glaucoma surgery before or at the same time carry a similar functional and anatomical success to eyes without glaucoma surgery.

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Section: Surgical Technique and Postoperative Carementioning

confidence: 99%

Intermediate-term Visual Outcomes and Complications of Type 1 Boston Keratoprosthesis With and Without Glaucoma Surgery

AlHilali

Martínez-Osorio

AlObaida

et al. 2022

Cornea

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“…Tubes may be implanted either in the anterior chamber or ciliary sulcus without vitrectomy, or as a pars plana tube with vitrectomy ( Figure 3 ). 18 , 19 Conjunctival scarring, crowded anterior chambers with iridocorneal adhesions, and the need for a good bandage contact lens fit postoperatively are considerations in deciding the position of tube placement. Reported outcomes from these combined procedures have been successful in controlling IOP with low risk of complications.…”

Section: Surgical Planningmentioning

confidence: 99%

Boston type 1 keratoprosthesis from patient selection through postoperative management: a review for the keratoprosthetic surgeon

Williamson¹,

Cortina²

2016

OPTH

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For the anterior segment surgeon, the implantation of Boston type 1 keratoprosthesis is a multistep process that begins with careful patient selection. Success depends on thorough preoperative evaluation, detailed surgical planning, and frequent postoperative follow-up. New practice patterns have emerged for each of these phases as the international experience with keratoprosthesis grows. This review details special considerations that can improve outcomes and also allow surgeons to consider its use in challenging patient populations at each step.

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“…Studies have shown that combined GDD and KPro surgery may result in improved perioperative IOP control. 8,9 Eyes with retinal detachment have a higher incidence of glaucoma than the general population, and patients requiring retinal detachment repair may benefit from combined surgery. Scarring of the conjunctiva and rectus muscles following scleral buckling can make future tube shunt placement technically challenging.…”

Section: Special Situationsmentioning

confidence: 99%

When Should We Perform Incisional Glaucoma Surgery?

Vinod¹,

Panarelli²

2015

US Ophthalmic Review

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GlaucomaTouch MEdical MEdia 43The decision to perform incisional glaucoma surgery is not an easy one.Surgery has traditionally been reserved for patients who are progressing or are deemed likely to progress despite maximally tolerated medical and/ or laser therapy. It is at this point that the risk for continuing to observe outweighs the risks for performing surgery. There are numerous factors to be considered before consenting a patient for surgery but we think the most essential part of this process is to remember that each patient is unique.One cannot look at a simple set of parameters and decide to operate if one value is outside of the normal range. The decision is far more complex. Risk-Benefit AnalysisGlaucoma tends to be a slowly progressive disease that can be monitored over time via changes in optic nerve appearance, visual fields (VFs), and optic nerve imaging. The conventional approach is to attempt medical therapy or laser trabeculoplasty prior to surgery to minimize risk to the patient. The efficacy of antiglaucoma medications may be limited in certain patients by local and systemic side effects.Despite a multitude of data to support the safety and effectiveness of traditional glaucoma surgery, including trabeculectomy and glaucoma drainage device (GDD) implantation, these procedures are associated with the potential for adverse effects. Postoperative complications following trabeculectomy with antimetabolite use include shallow or flat anterior chamber, hypotony, choroidal effusions, bleb encapsulation, bleb leak, and blebitis/endophthalmitis. Complications relating more specifically to GDD implantation include tube obstruction, tube erosion, and motility disturbances. 1,2 What Factors Influence My Decision-making Process?The intraocular pressure (IOP) should first be evaluated and one must try to determine if the patient is progressing or likely to progress at this IOP.When the IOP is at a level that is clearly too high, 30-50 mmHg, then the decision is straightforward. However, when the IOP is in the 20-30 mmHg range or even lower, the decision is not so straightforward and other measures need to be evaluated to make a proper decision. We next evaluate the VFs and see if there is clear progression on testing. Apparent progression necessitates confirmation with repeat VFs, as substantiated by the Collaborative Normal Tension Glaucoma Study. 3 Chauhan et al. recommend a minimum of six VFs over 2 years to confirm progression. 4We will often compare disc photographs and structural testing of the optic nerve to see if there has been progressive damage. This is more helpful is cases of preperimetric glaucoma and elevated IOP. When a patient has advanced disease, we find VF testing to be more helpful in judging progression. AbstractDeciding when to perform glaucoma surgery can be challenging despite evidence in the literature supporting its safety and efficacy. In addition to clinical examination, visual field testing, and optic nerve imaging, other patient factors such as age, family history, and ocula...

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Technique of Combined Glaucoma Tube Shunt and Keratoprosthesis Implantation

Abstract: Combined GDD and KPro surgery provides the opportunity of additional IOP management and restoring vision in the same setting, saving the patient from additional glaucoma surgery, and is not associated with an increased KPro retention failure rate or other secondary complications.

Cited by 15 publications

References 18 publications

Intermediate-term Visual Outcomes and Complications of Type 1 Boston Keratoprosthesis With and Without Glaucoma Surgery

Intermediate-term Visual Outcomes and Complications of Type 1 Boston Keratoprosthesis With and Without Glaucoma Surgery

Boston type 1 keratoprosthesis from patient selection through postoperative management: a review for the keratoprosthetic surgeon

When Should We Perform Incisional Glaucoma Surgery?

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