Pho Nguyen1, Vikas Chopra. 1. aDoheny Eye Institute bDepartment of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Abstract
PURPOSE OF REVIEW: To review the literature on management of glaucoma in Boston keratoprosthesis type I recipients. RECENT FINDINGS: Glaucoma is a prevalent and important cause of permanent loss of sight in Boston keratoprosthesis recipients. The management of glaucoma is challenging as there are no reliable and accurate means to monitor the intraocular pressure (IOP) in these patients, and no standardized protocols exist regarding management. Because a significant number of patients require glaucoma drainage device placement, further studies are needed to determine ways to reduce the risk of shunt-associated complications. Surgical adjustments including posterior shunt placement, adjunctive corneal patch graft, and selection of a different size bandage contact lens can help reduce shunt-associated complications. Anterior segment optical coherence tomography is useful in elucidating the mechanisms of failure to control IOP. Continual innovations in imaging and IOP measurement technologies will assist surgeons' preoperative planning and postoperative management. SUMMARY: In keratoprosthesis recipients, glaucoma often leads to permanent loss of sight. It is imperative that these patients be monitored with vigilance by a multidisciplinary team to prevent progression. Pooled data from multiple centers and technologic innovations will assist the surgeon to design a surgical approach and postoperative management regimen for the individual recipient.
PURPOSE OF REVIEW: To review the literature on management of glaucoma in Boston keratoprosthesis type I recipients. RECENT FINDINGS:Glaucoma is a prevalent and important cause of permanent loss of sight in Boston keratoprosthesis recipients. The management of glaucoma is challenging as there are no reliable and accurate means to monitor the intraocular pressure (IOP) in these patients, and no standardized protocols exist regarding management. Because a significant number of patients require glaucoma drainage device placement, further studies are needed to determine ways to reduce the risk of shunt-associated complications. Surgical adjustments including posterior shunt placement, adjunctive corneal patch graft, and selection of a different size bandage contact lens can help reduce shunt-associated complications. Anterior segment optical coherence tomography is useful in elucidating the mechanisms of failure to control IOP. Continual innovations in imaging and IOP measurement technologies will assist surgeons' preoperative planning and postoperative management. SUMMARY: In keratoprosthesis recipients, glaucoma often leads to permanent loss of sight. It is imperative that these patients be monitored with vigilance by a multidisciplinary team to prevent progression. Pooled data from multiple centers and technologic innovations will assist the surgeon to design a surgical approach and postoperative management regimen for the individual recipient.
Authors: Allister Gibbons; Ella H Leung; Luis J Haddock; Carlos A Medina; Viviana Fernandez; Jean-Marie A Parel; Heather A Durkee; Guillermo Amescua; Eduardo C Alfonso; Victor L Perez Journal: Clin Ophthalmol Date: 2018-02-15