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Glaucoma a common finding after KPro implantation
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NEW ORLEANS — One in four eyes with pre-existing glaucoma may develop worsening disease after implantation with the Boston type 1 keratoprosthesis, and up to one in five eyes without pre-existing glaucoma may develop new onset glaucoma after implantation, according to a study presented at the American Society of Cataract and Refractive Surgery meeting.
Whereas glaucoma is a common comorbid condition in patients undergoing KPro implantation, detection and monitoring of glaucoma after implantation are “notoriously difficult,” Kavitha R. Sivaraman, MD, said.
Sivaraman and colleagues conducted a retrospective chart review of 195 eyes implanted with the KPro at the Cincinnati Eye Institute between July 2003 and April 2015 to quantify the incidence of new onset glaucoma and to quantify the rate of progression of pre-existing glaucoma in eyes after KPro implantation.
Charts were reviewed for diagnosis of glaucoma before KPro implantation, worsening of pre-existing glaucoma after implantation and development of new onset glaucoma after implantation.
New onset glaucoma was defined as an increase in tactile IOP and/or glaucomatous optic nerve appearance requiring initiation of ocular antihypertensive medication or surgical glaucoma procedure. Worsening glaucoma was defined as escalation of baseline preoperative glaucoma therapy, such as the need for additional medications or glaucoma surgery.
Of 124 eyes with pre-existing glaucoma, 64 had a tube shunt before implantation with KPro, and about 73% remained stable with no escalation of therapy, Sivaraman said.
“Looking at the other side of the coin at the other set of eyes without glaucoma going in, postoperatively about 20% went on to develop new onset glaucoma,” she said. “However, the overwhelming majority, about 80%, did not.” Eight eyes required a tube shunt for IOP control after KPro implantation, and nine required diode cyclophotocoagulation.
Sivaraman said the duration of follow-up in the study, a mean of 33 months, could be a limiting factor in that it could take longer than that for complications to arise. – by Patricia Nale, ELS
Reference:
Sivaraman KR. Development and progression of glaucoma in eyes with collar-button design keratoprosthesis. Presented at: American Society of Cataract and Refractive Surgery meeting; May 6-10, 2016; New Orleans.
Disclosure: Sivaraman reports no relevant financial disclosures.