Glaucoma and keratoprosthesis surgery: role of adjunctive cyclophotocoagulation.
OBJECTIVE
To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation (DLTSC) to control intraocular pressure (IOP) in keratoprosthesis patients with uncontrolled glaucoma.


METHODS
Between 1993 and 2007, 18 eyes of 18 patients underwent DLTSC, either before (n=3), during (n=1), or after (n=14) keratoprosthesis surgery. Keratoprosthesis type I was used in 72%. All but one of these patients received an Ahmed Glaucoma Valve, either with or after the keratoprosthesis placement. Best-corrected visual acuity, IOP (assessed by digital palpation), number of medications, and complications were recorded preoperatively, at day 7, at 1, 3, and 6 months then every 6 months postoperatively.


RESULTS
Mean follow-up was 26.6+/-19.6 months (mean+/-SD) and mean age was 50.1+/-15.6 years. Glaucoma was identified in 11 eyes before keratoprosthesis surgery and in 7 eyes after. Mean postoperative IOP was significantly reduced at 6, 12, 24, 36, and 48 months after DLTSC. DLTSC was repeated in 6 eyes. At final visit, mean best-corrected visual acuity was not decreased and there were no statistically significant differences in the number of glaucoma medications. Two patients had complications after DLTSC: a conjunctival dehiscence and a fungal endophthalmitis.


CONCLUSIONS
DLTSC has beneficial long-term effects in the control of IOP and can be considered in the management of keratoprosthesis patients with refractory glaucoma.
Glaucoma Consultation Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, USA.
Delphine
D
Rivier
Jayter S
JS
Paula
Eva
E
Kim
Claes H
CH
Dohlman
Cynthia L
CL
Grosskreutz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001187:Artificial Organs; D002924:Ciliary Body / Q000601:surgery*; D003315:Cornea; D003316:Corneal Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D017075:Laser Coagulation; D054023:Lasers, Semiconductor / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014792:Visual Acuity / Q000502:physiology