Monitoring Of Glaucoma After The Implantation Of...

Monitoring Of Glaucoma After The Implantation Of Keratoprosthesis

M. Papadia1, R. Scotto1, A. Bagnis1, A. Macrì2, C.E. Traverso1 1.Clinica Oculistica, DiNOG, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino - IST,

Genoa, Italy

2. IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy

Commercial  Rela,onship:  R  Sco&o,  None;  M  Papadia,  None;  A  Bagnis,  None;  A  Macrì,  None;  C  E  Traverso,  None.  

PATIENTS  AND  METHOD  Pa,ent   1:   Female,   age   80,   preoperaBve   corneal   diagnosis  was   graD   failure   in   associaBon  with   glaucoma,   pre-­‐operaBve   best   corrected  visual  acuity  (BCVA)  was  finger  counBng  (FC),  post-­‐operaBve  BCVA  was  20/63.  This  paBent  received  anB-­‐glaucoma  treatment  before  and  aDer  Kpro  surgery  with  Bmolol,  latanoprost  and  oral  acetazolamide.  Pa,ent  2:  Male,  age  54,  preoperaBve  corneal  diagnosis  was  bilateral  chemical  injury,    pre-­‐operaBve  BCVA  was  light  percepBon  (LP),  post-­‐operaBve  BCVA  was  20/50,  digital  assessment  of  IOP  was  normal  before  and  aDer  surgery.    Pa,ent  3:  Male,  age  42,  preoperaBve  corneal  diagnosis  was  graD-­‐versus-­‐host  disease,  pre-­‐operaBve  BCVA  was  light  percepBon  (LP),  post-­‐operaBve  BCVA  was  20/40,  digital  assessment  of  IOP  was  normal  before  and  aDer  surgery.  

Intraocular  pressure  assessment  was  performed  by  palpaBon.  Visual  fields  were  performed  aDer  surgery  by  using  automated  perimetry  with  Humphrey  SITA  Standard  programs  and  with  Octopus  Dynamic  programs.  OpBc  nerve  and  ReBnal  Nerve  Fiber  Layer  evaluaBon  were  performed  with  HRT  III  (Heidelberg  Engineering)  and  Rtvue  OCT  (Optovue,  Inc).  Reliability  indexes  of  HRT,  OCT  and  VF  fixaBon  losses  were  28,5  μm  (±7,8),  38,4  (±7,9),  1,4/17.  

INTRODUCTION  The  Boston  type  1  keratoprosthesis,  approved  by  the  Food  and  Drug  AdministraBon  in  1992,  was  developed  for  paBents  who  are  poor  candidates  for  tradiBonal  keratoplasty  because   of   a   high   risk   of   graD   failure   or   rejecBon.   Long-­‐term   complicaBons   of   the  Boston  type  1  Kpro,  including  glaucoma,  are  well  documented  by  the  literature.  The   rate   of   extrusion   and   endophthalmiBs   aDer   KPro   surgery   is   significantly   lower  since   the   introducBon   of   bandage   contact   lenses,   prophylacBc   anBbioBcs,   and   an  improved  threadless  design.  Despite  such  advances,  glaucoma  can  compromise  visual  rehabilitaBon  in  these  paBents  in  spite  of  a  clear  opBcal  window.  

Figure 1: Scheme of Boston Kpro 1

Figure 2: Patient before surgery

Figure 2: Patient after Boston KPro surgery

CONCLUSION  The  Boston  type  1  Keratoprosthesis  is  an  important  and  viable  opBon  for  salvaging  vision  aDer  mulBple  keratoplasty  failures  and  in  paBents  with  a  high  risk  of  failure  with  tradiBonal  graDing  methods.  Glaucoma  emerges  as  an  important  long-­‐term  complicaBon  of  this  procedure.  Monitoring  of   IOP   is  extremely  difficult,   is   complicated  by   the   lack  of  objecBve   tonometry,   leaving  clinicians  with  no  other  means   than  palpaBon  to  evaluate  IOP.  Visual  field  examinaBon  and  imaging  methods  are  paramount  for  glaucoma  monitoring;  we  show  the  feasibility  in  paBents  implanted  with  a  keratoprosthesis.      

References  -­‐   Netland  PA,  Terada  H,  Dohlman  CH.  Glaucoma  associated  with  keratoprosthesis.  Ophthalmology.  1998  Apr;105(4):751-­‐7.  -­‐   Gomaa  A,  Comyn  O,  Liu  C.  Keratoprostheses  in  clinical  pracBce  -­‐  a  review.  Clin  Experiment  Ophthalmol.  2010  Mar;38(2):211-­‐24.    -­‐  Greiner  MA,  Li  JY,  Mannis  MJ.  Longer-­‐term  vision  outcomes  and  complicaBons  with  the  Boston  type  1  keratoprosthesis  at  the  University  of  California,  Davis  Ophthalmology.  2011  Aug;118(8):1543-­‐50.  -­‐   Li  JY,  Greiner  MA,  Brandt  JD,  Lim  MC,  Mannis  MJ.  Long-­‐term  complicaBons  associated  with  glaucoma  drainage  devices  and  Boston  keratoprosthesis.  Am  J  Ophthalmol.  2011  Aug;152(2):209-­‐18.  -­‐   Talajic  JC,  Agoumi  Y,  Gagné  S,  Moussally  K,  Harissi-­‐Dagher  M.  Prevalence,  progression,  and  impact  of  glaucoma  on  vision  aDer  Boston  type  1  keratoprosthesis  surgery.  Am  J  Ophthalmol.  2012  Feb;153(2):267-­‐274.  -­‐   Kamyar  R,  Weizer  JS,  de  Paula  FH,  Stein  JD,  Moroi  SE,  John  D,  Musch  DC,  MianSI.  Glaucoma  associated  with  Boston  type  I  keratoprosthesis.  Cornea.  2012Feb;31(2):134-­‐9.