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Title:

Role and timing of glaucoma surgery in boston keratoprosthesis type 1 patients


Poster Details

First Author: D. Geoffrion CANADA

Co Author(s):    M. Harissi-Dagher                    

Abstract Details

Purpose:

Glaucoma often develops or progresses after Boston keratoprosthesis type I (KPro) implantation, and it can be managed using glaucoma surgery during follow-up. The purpose of this study is to determine the role and optimal timing of glaucoma surgery in relation to KPro implantation.

Setting:

Centre hospitalier de l'Universit´┐Ż de Montr´┐Żal, Montreal (Quebec), Canada

Methods:

Retrospective study of 140 eyes of 118 patients who underwent KPro implantation between 2008-2017. 100 eyes of 100 patients diagnosed with glaucoma were included. Patients were separated into 2 groups: those with preexisting glaucoma and those who developed glaucoma de novo after KPro. Groups were then divided based on whether patients were medically or surgically managed. Glaucoma surgery included glaucoma drainage device (GDD) implantation, trabeculectomy, and cyclophotocoagulation (CPC). Outcomes included best-corrected visual acuity (BCVA), glaucoma progression, and complications. Differences in outcomes were compared using parametric and non-parametric tests, as well as log-rank test to compare time-to-outcome events.

Results:

Among 72 eyes with preexisting glaucoma, 27 (38%) had glaucoma surgery before KPro (18 GDD), while 45 (62%) were only medically managed. Among the latter, 19 (42%) needed glaucoma surgery post-KPro (16 GDD). Among 28 eyes with de novo glaucoma, 12 (43%) had glaucoma surgery post-KPro (9 GDD). Eyes with preexisting glaucoma had greater glaucoma progression with glaucoma surgery performed post-KPro (100%) compared to pre-KPro (74%, P=0.016) and to medical management (54%, P=0.002). Fewer eyes maintained BCVA?20/200 over time with medical management (P=0.013). Eyes with de novo glaucoma had similar progression, BCVA and complications between medical and surgical care (P>0.05).

Conclusions:

Glaucoma surgery should be performed prior or concurrently to KPro in eyes with preexisting glaucoma. Complication rates are not increased when glaucoma surgery is performed in KPro eyes with de novo glaucoma. To ensure optimal IOP control, glaucoma surgery should be performed early in those eyes.

Financial Disclosure:

None




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