Prognosis And Visual Outcomes Of Glaucoma Drainage Devices Vs Cyclodestructive Procedures In Patients With Keratoprosthesis.

Several studies have described and compared the timing of the glaucoma surgical intervention in Patients with keratoprosthesis. However, there is a minimum data in the literature directly comparing any of these surgical options in terms of success rate, complications, number of medications, and the need for additional surgical intervention.

 In this study, we evaluated and compared the efficacy and safety of concomitant glaucoma therapy using glaucoma drainage devices (GDDs), MicroPulse transscleral cyclophotocoagulation (MPCPC), Ultrasound cycloplasty (UCP), and Endoscopic cyclophotocoagulation (ECP) in patients who underwent Keratoprosthesis (KPro) at a tertiary eye hospital in Riyadh, Kingdom of Saudi Arabia (KSA).

This is a retrospective cohort study of patients with Keratoprosthesis who underwent concomitant glaucoma therapy at a tertiary eye hospital in Riyadh, Kingdom of Saudi Arabia (KSA) from January 2009 December 2022 with a minimum of 1-year follow-up. Patients who were lost to follow-up and patients who underwent keratoprosthesis alone without any concomitant glaucoma intervention were excluded from the study.

Patients were categorized into 2 main groups: Group 1 were they underwent Kpro with a concomitant GDD (16 patients), and Group 2 were they underwent Kpro with a concomitant cyclodestructive procedure (28 patients) including CPC, UCP, or ECP. IOP measurements post-Kpro were estimated digitally by a senior ophthalmologist in which “soft” was defined as IOP ranging from 0 to 5 mm Hg, “normal” from 6 to 20 mm Hg and “high” for IOP estimated as above 21 mm Hg. Failure of the glaucoma surgery was defined as 2 or more episodes of high IOP. Data was collected from electronic records in a specifically designed data collection sheet, data then was entered and stored in Microsoft Excel 365. The analysis was conducted using SPSS version 26.0.

Success rate for the 1st group was 68.75% compared to the 2nd group with 75% success rate. UCP had the highest success rate with 80%, CPC and ECP reported a success rate of 72.73% and 50% respectively. The complication rate was also higher in the 1st group 56.25% as opposed to 20% in Kpro plus UCP patients, 26.6% in Kpro plus CPC patients and 50% in Kpro plus ECP patients. Twenty-five percent of the 1st group needed an additional glaucoma surgery, in contrast to only 6.6% in patients who underwent Kpro with UCP and 9.9% in Kpro plus CPC patients.On the other hand, both groups had the same outcome regarding patients who needed additional glaucoma medications post-op compared to pre-op with 25% from each group.