Glaucoma associated with keratoprosthesis

• Published in: Ophthalmology (Rochester, Minn.) Vol. 105; no. 4; pp. 751 - 757
• Main Authors: Netland, Peter A, Terada, Hisao, Dohlman, Claes H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.1998; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cornea - surgery; Corneal Diseases - surgery; Drainage - instrumentation; Female; Follow-Up Studies; Glaucoma - etiology; Glaucoma - prevention & control; Glaucoma - surgery; Humans; Intraocular Pressure; Male; Medical sciences; Middle Aged; Postoperative Complications; Prostheses and Implants - adverse effects; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Visual Acuity; Visual Fields; Human; Postoperative; Eye disease; Cornea; Iatrogenic; Glaucoma (eye); Prosthesis; Surgery; Complication
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/S0161-6420(98)94034-9

This study aimed to review the authors clinical experience with glaucoma associated with keratoprosthesis in patients with severe corneal disease. The study design was a retrospective review of case series. The authors studied 55 eyes in 52 patients with keratoprostheses with follow-up of 21 ± 16 months (range, 3–77 months). Glaucoma drainage devices were implanted in 36 eyes (35 Ahmed valves, 1 Krupin valve) with 21 ± 15 months’ follow-up (range, 3–64 months). Clinical outcome assessment included vision, intraocular pressure (IOP), visual fields, optic disc appearance, and identification of complications. 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. Elevation of IOP is common in patients with keratoprosthesis, and prevention or treatment with glaucoma drainage implants is effective.