title: Prevalence, progression, and impact of glaucoma on vision after Boston type 1 keratoprosthesis surgery.
abstract: OBJECTIVE
  To report glaucoma outcomes after Boston type 1 keratoprosthesis (KPro) surgery, in particular, glaucoma prevalence, progression, and treatment.
  
  
  METHODS
  Consecutive, retrospective, interventional case series.
  
  
  METHODS
  setting: Tertiary care institution. study population: Thirty-eight eyes in 38 patients. intervention: KPro surgery. main outcome measures: Visual acuity (VA), intraocular pressure, visual fields, optic nerve status, and glaucoma treatment.
  
  
  RESULTS
  Glaucoma diagnosis was known before surgery in 29 patients (76%; 14 had undergone previous surgery) and was diagnosed after surgery in 34 patients (89%) after a mean ± standard deviation of 16.5 ± 4.7 months of follow-up. The number of patients taking intraocular pressure-lowering medications increased from 19 (50%) before surgery to 28 (76%) after surgery (P = .017). Twenty-four patients (63%) were taking at least 1 additional glaucoma medication at their most recent postoperative visit. Eight patients (21%) had glaucoma progression (visual field progression, need for surgery, or both). Fifteen patients (40%) had a cup-to-disc ratio of 0.85 or more. Five patients required glaucoma surgery. VA was limited by glaucoma in 14 patients (37%), 11 of whom had a VA of 20/200 or worse. Five such patients (13%) had a dramatic improvement in VA, then progressed to end-stage glaucoma with fixation loss. Visual fields were limited by glaucoma in 25 patients (66%; mean Swedish Interactive Threshold Algorithm Fast mean defect, -20.3 ± 8.8 decibels; n = 18).
  
  
  CONCLUSIONS
  Most KPro candidates have glaucoma, which may deteriorate in a subset of patients after surgery. Dramatic VA improvement after KPro surgery does not preclude the need for rigorous monitoring for glaucoma progression. A low threshold should be used to treat suspicion of even slightly elevated intraocular pressure.
authors: Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada.
authors: Julia C
authors: JC
authors: Talajic
authors: Younes
authors: Y
authors: Agoumi
authors: Sébastien
authors: S
authors: Gagné
authors: Krystel
authors: K
authors: Moussally
authors: Mona
authors: M
authors: Harissi-Dagher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001187:Artificial Organs; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D018463:Filtering Surgery; D005901:Glaucoma / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019736:Prostheses and Implants; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents