Management of Glaucoma Associated with Boston KPro Type I Implantation
Glaucoma affects a majority of eyes undergoing Boston Type I Keratoprosthesis (KPro; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA) surgery and is associated with poorer postoperative outcomes. Pathophysiologic factors include underlying
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Ahmad A. Aref and Thasarat S. Vajaranant
Contents
12.1
12.1
Scope of the Problem ...............................
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12.2
Pathophysiology .......................................
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12.3
Diagnosis/Monitoring ..............................
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12.4
Therapeutic Options ................................
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12.5
Medical Therapies....................................
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12.6
Laser Therapies........................................
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12.7
Incisional Therapies.................................
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Conclusions .............................................................
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References ...............................................................
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Electronic supplementary material Supplementary material is available in the online version of this chapter at 10.1007/978-3-642-55179-6_12. Videos can also be accessed at http://www.springerimages.com/ videos/978-3-642-55178-9. A.A. Aref, MD (*) • T.S. Vajaranant, MD Glaucoma Service, Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois School of Medicine, 1855 W. Taylor Street, MC 648, Suite 3.171, Chicago, IL 60612, USA e-mail: [email protected]; [email protected]
Scope of the Problem
Progressive postoperative glaucomatous optic neuropathy often compromises visual rehabilitation after otherwise successful Boston Type I Keratoprosthesis (KPro; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA) surgery. In a retrospective review of 55 eyes that underwent KPro surgery, Netland et al. reported that glaucoma occurred in the majority (64 %) of eyes [1]. Glaucoma was found to occur before surgery in 36 % of eyes and after surgery in another 28 % of eyes after a mean follow-up of 21 ± 16 months. Talajic et al. reported an even higher prevalence of glaucoma in this patient population, reporting a total prevalence of 89 % in 38 eyes with a mean follow-up time of 16.5 ± 4.7 months [2]. Patients with a preoperative diagnosis of glaucoma were noted to require an increased number of intraocular pressure (IOP)-lowering medications and 21 % experienced documented glaucomatous progression after KPro surgery. Kamyar et al. found that KPro eyes experiencing glaucoma development or progression achieved a lower postoperative mean best-corrected visual acuity (mean = 3/200) compared with nonglaucomatous eyes (mean = 20/563) [3]. Current evidence clearly shows that glaucomatous optic neuropathy affects a majority of eyes undergoing KPro surgery and is associated with poorer postoperative outcomes.
M. Soledad Cortina, J. de la Cruz (eds.), Keratoprostheses and Artificial Corneas: Fundamentals and Surgical Applications, DOI 10.1007/978-3-642-55179-6_12, © Springer-Verlag Berlin Heidelberg 2015
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A.A. Aref and T.S. Vajaranant
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12.2
Pathophysiology
A significant proportion of candidates for KPro surgery have a preexisting history of glaucoma. In prior retrospective studies evaluating the outcomes of KPro surgery, preexisting glaucoma occurred in 36–76 % of eyes [1–4]. This relatively hig
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