Glaucoma associated with keratoprosthesis

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.