Author/Editor		Črnej, Alja; Paschalis, Eleftherios I.; Salvador-Culla, Borja; Tauber, Allyson; Drnovšek-Olup, Brigita; Shen, Lucy Q.; Dohlman, Claes H.
Title		Glaucoma progression and role of glaucoma surgery in patients with Boston keratoprosthesis
Type		članek
Vol. and No.		Letnik 33, št. 4
Publication year		2014
Volume		str. 349-354
ISSN		0277-3740 - Cornea
Language		eng
Abstract		Purpose: The aim of this study was to evaluate glaucoma onset and progression after implantation o f Boston Keratoprostheses (B-KPro) and the role of glaucoma surgery. Methods: Records of patients with B-KPro implantation during 2004 to 2009 were reviewed. Parameters relevant to B-KPro surgery and glaucoma status were recorded. The data were analyzed in 5 groups based on the preoperative diagnosis. Results: One hundred six eyes of 87 patients were included, and the average age was 54 6 6.7 years. Forty-six percent were female. Eighteen eyes had a B-KPro with a titanium back plate, and the others had a poly(methyl methacrylate) back plate. Thirty-three eyes were pseudophakic, and the rest were left aphakic. The follow-up time was 3.3 6 1.0 years. Indications for implantation included past infection, congenital glaucoma, trauma, autoimmune diseases, anir- idia, burns, and others. Sixty-six percent of the eyes had glaucoma preoperatively, and 26% developed de novo glaucoma afterward. The mean intraocular pressure (by fi nger palpation) was 16.5 6 5.7 mm Hg. Reliable visual fi eld tests were only available in 59% of the eyes; hence, the cup-to-disc ratio of the optic nerve head was used as the main outcome measure. In B-KPro - implanted eyes with glaucoma, 65% had undergone glaucoma surgery at some point, and 30% did not show progression. Thirty-one percent of the total cohort had disc pallor with a cup-to-disc ratio of < 0.8. Conclusions: 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 implanta- tion. The high number of eyes with disc pallor suggests that additional mechanisms other than elevated intraocular pressure may play a role in optic neuropathy.
Keywords		Boston keratoprosthesis glaucoma glaucoma surgery Bostonska keratoproteza glavkom operacija glavkoma