Elsevier

Ophthalmology

Volume 105, Issue 4, 1 April 1998, Pages 751-757
Ophthalmology

Glaucoma associated with keratoprosthesis1,

Presented in part as a poster at the American Academy of Ophthalmology Annual Meeting, Chicago. Illinois, October, 1996.
https://doi.org/10.1016/S0161-6420(98)94034-9Get rights and content

Abstract

Objective

This study aimed to review the authors clinical experience with glaucoma associated with keratoprosthesis in patients with severe corneal disease.

Design

The study design was a retrospective review of case series.

Participants

The authors studied 55 eyes in 52 patients with keratoprostheses with follow-up of 21 ± 16 months (range, 3–77 months).

Intervention

Glaucoma drainage devices were implanted in 36 eyes (35 Ahmed valves, 1 Krupin valve) with 21 ± 15 months’ follow-up (range, 3–64 months).

Main outcome measures

Clinical outcome assessment included vision, intraocular pressure (IOP), visual fields, optic disc appearance, and identification of complications.

Results

Glaucoma was found in the majority (64%) of eyes treated with keratoprostheses, identified in 20 eyes (36%) before surgery and an additional 15 eyes (28%) after surgery. Of the 36 eyes treated with glaucoma drainage devices, IOP was controlled in 29 eyes (81%), with 9 eyes (25%) requiring additional medications. Continued progression of glaucoma occurred in 5 (14%) of 36 eyes with keratoprostheses and glaucoma drainage implants (4 of these eyes had advanced glaucomatous optic nerve damage before surgery). There were nine nonvision-threatening complications due to drainage implants. Compared with the preoperative visual acuity, vision was markedly improved in 63%, unchanged in 17%, and worse in 20% of eyes after keratoprosthesis surgery.

Conclusion

Elevation of IOP is common in patients with keratoprosthesis, and prevention or treatment with glaucoma drainage implants is effective.

Section snippets

Methods

Patients treated with keratoprosthesis and glaucoma drainage implant gave verbal consent and signed an informed consent form approved by the Institutional Review Board. Eyes with keratoprostheses were from a consecutive series of cases performed from March 1990 to June 1996. No eyes with keratoprosthesis implanted during this period were excluded from the analysis. Glaucoma drainage implants were performed in eyes with keratoprosthesis from February 1991 to June 1996. The surgical procedures

Results

The characteristics of the patients are listed in Table 1. A total of 55 keratoprostheses were implanted in 52 patients. The mean ± standard deviation age was 64 ± 19 years, with a range of 24 to 93 years. The follow-up period was 21 ± 16 months, with a range of 3 to 77 months. Glaucoma drainage devices were implanted in 36 eyes (65% of total) in 34 patients (65% of total). The type of keratoprosthesis was significantly different in the patients with and without glaucoma drainage implants (P =

Discussion

Keratoprosthesis may be the only option for visual rehabilitation of certain patients with severe ocular surface disease, including those with ocular cicatricial pemphigoid, Stevens-Johnson syndrome, end-stage dry eye, severe chemical burns, and repeated failure of penetrating keratoplasty. However, these patients may have a high incidence of glaucoma even before keratoprosthesis implantation. In a series of 111 patients (none with keratoprosthesis) with ocular cicatricial pemphigoid, 29

Acknowledgements

The authors thank Dr. C. Stephen Foster for patient referrals.

References (19)

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Supported by Mr. Sa’ad A. A. Al-Rashed, Kuwait.

1

The authors have no propriety interest in the devices used in this study.

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